Week 8- Post Partum Problems in the mare Flashcards
What are considered to be retained foetal membranes?
- retained if not passed within 3 hours
- disturbance of normal uterine activity
- affects up to 10% of mares
- membranes on non-pregnant horn most likely to be retained
- most common if problem is during pregnancy or parturition
- draft breeds most at risk
What is the clinical presentation of retained foetal membranes?
- placental tissue protruding from the vulva
- examine placenta post-partum
- if torn- use vessels to assess whether a portion is missing
What happens if RFM is prolonged?
- metritis
- endotoxaemia
- laminitis
How might you treat RFM?
membrane hanging in hocks or below
* tie in a knot
* encourage passage and reduces trauma
What happens if RFM is retained for 2 hours?
give low dose oxytocin IM hourly
What do you do if RFM for 6 hours?
- attempt manual removal
- clinically evaluate the mare again
- administer oxytocin + sedative
- tail bandage and clean perineum
- apply gently traction on allantochorion
- slie hand between endometrium and allantochorium to aid separation
- intravenous infusion with oxytocin
What are the three options for RFM further therapy?
- if twisted- separate allantochorion from endometrium
- if distended- 12 litres of 0.01% iodine solution
clean NG tube - tied with umbilical table
- fluid maintained for 30 minutes
How would you catheterise the umbilic vessel?
- through a foal NG tube
- placenta passes within 5-10 minutes
What medication is used if retained for over 6 hours?
- systemic antibiotic s
- NSAIDS
- Laminitis support- cryotherapy
What is the prognosis for RFM?
Excellent if treated appropriately
What is metritis and when does it present?
- low incidence
- presents with birth trauma
- presents 2-4 days PP
- inflammation of the uterine wall permits bacteria
What is the clinical presentation of metritis?
- Signs of endotoxaemia
- fever, anorexia, tachycardia, congested MM
- laminitis
- Vaginal discharge
- pronounced neutropenia
How might you treat metritis?
- Broad-spectrum antibiotics
- NSAIDS
- IV fluid
- oxytocin
- uterine lavage
- broad spectrum uterine antibiosis
- prevent/ treat laminitis
Why may vulval trauma occur?
- failure to open caslick
- large foal size
When do perineal lacerations occur?
- maiden mares
- malpresentations
- normal foaling…
What is a first degree perineal laceration?
- vulval lips
- dorsal vulval commisure
- may heal spontaneously if mild
- repair using caslicks if bigger
What is a second degree perineal laceration?
- mucosa, submucosa of vestibule
- often impairs vestibulo-vulval seal
- generally requires surgical repair
- healthy granulation tissue needs to be present for repair
What is a third degree perineal laceration?
- all layers of the vestibule
- faecal contamination
- can involve cranial tissues
- peritoneal contamination
- Antibiotics, NSAIDS, LAXITIVES
*
What is the surgical repair for a third degree PL?
- assess after secondary intention healing
- laxatives
- sedate and epidural
- reconstrcut vaginal roof
What is the most common cause of recto-vaginal fistula?
foal foot penetration
What is urovaginum?
- cranial displacement of vagina and urethral orifice
- cervicitis
- scald
- constant urine discharge
- usually resolves spontaneously
How would you treat urovaginum?
- urethral extension surgery if it persists
What is peri-parturient haemorrhage?
- rupture of middle uterine artery
- 40% of mare deaths after foaling
- risk of haemorrhae increases in older mares with multiple foals
What happens with a uterine artery bleed?
Mainly contained within broad ligament → haematoma
➢ Can occur within uterine wall
➢ Enter uterine lumen → vulval bleeding
➢ Or directly into abdominal cavity
➢ Haematomas may subsequently rupture and leak into
abdomen
What happens with a vulvar bleeding?
➢ Associated with trauma to uterine or vaginal vessels
➢ A haematoma here may present as a large unilateral
vulvar swelling
What is the clinical presentation of a per-parturient haemorrhage?
Dependant on location and degree of haemorrhage
* Vulval bleeding → very little signs of discomfort
* If contained within broad ligament or uterine or pelvic wall
➢ Mare will show signs of colic
➢ Painful stretching of the tissues
* If artery ruptures into peritoneal cavity
➢ May not be painful but haemorrhage profuse and rapidly fata
How might you diagnose a peri-parturient haemorrhage?
Careful rectal palpation and ultrasonography
➢ Large swelling
➢ Blood may be free flowing or clotted
➢ Do NOT disturb existing clot
* Palpation per vaginum
➢ Assess vaginal trauma
* Haematology
➢ Acute phase – PCV may be normal due to splenic contraction. Hypoproteinaemia.
➢ Following days – see the drop in PCV before regenerative response
* Transabdominal ultrasound → detect free fluid in abdomen
* Abdominocenteis → confirm haemabdomen
What are the two main treatments of peri-parturient haemorrhage?
- Shock therapy
- Conservative therapy
What is shock therapy?
- IVFT → Hypertonic saline followed by isotonic fluids
- Supplemental oxygen
- If PCV <15 = Whole blood transfusion
What is conservative therapy?
Light sedation – alpha 2 agonist (only if mare stressed)
* Analgesia – flunixin or opiates
* Broad spectrum antibiosis → prevent abscessation of haematoma
* Low dose oxytocin → promote uterine involution
What are the three additional therapies for peri-parturient haemorrhage?
- Transexaemic acid
- Formalin
- Naloxane
What are the clinical signs of uterine laceration?
dependant on
* severity of laceration
* degree of contamination of peritoneal cavity & uterus
➢ Early → no obvious outward signs
➢ 24-72 hours→ fever, inappetence, reduced gut motility, abdominal pain
How might you diagnose uterine laceration?
Digital palpation
➢ challenging – tear may be small or out of reach
* Abdominocentesis
➢ Septic peritonitis
* Haematological changes
➢ infection
How might you treat uterine laceration?
Small laceration
➢ Medical Treatment
* Broad spectrum antibiotics
* Flunixin
* Oxytocin
* IVFT
* Large laceration
➢ Surgical repair
How might you treat a uterine prolapse?
Keep uterus supported w/ clean sheet
* Sedate mare + epidural
* Clean uterus with warm water or saline and inspect
➢ remove any remaining foetal membranes
* Massage back through vulval lips
* Then distend uterus with saline to ensure tips of horns fully
replaced and to lavage uterus
What medications would you use for a uterine prolapse?
- Broad spectrum antimicrobials
- NSAIDs e.g flunixin
- Oxytocin ONLY once replaced→ increase uterine tone
- Fluid therapy if required
What would you do if the uterine horn tip has been inverted?
Mild to severe colic
* Rectal palpation → short, thickened uterine horn
* Tx: Manual reduction & infusion of saline into uterus
How might you treat hypogalactia?
- Good nutrition
- Oxytocin to enhance milk let down
- Domperidone (dopamine antagonist)
➢ Twice daily 2-4 days
➢ Once daily 6-8 days
