Equine Parturition

Question 1

How can we predict parturition?

Answer 1

Date of conception.
Estimate foetal age.
Relaxation of pelvic ligament.
Examine mammary glands.
Mammary secretions.
Foaling alarms - recumbency or sweat.

Question 2

1. Milk electrolyte changes before parturition.
2. How can we test for milk electrolyte changes?

Answer 2

1. Increase calcium, increase potassium, decrease sodium, more acidic (decrease pH).
   - Calcium >200ppm then 84% of foaling w/in 48hrs.
2. Commercial kites.
   - Predict-a-foal for Ca and Mg.
   - FoalWatch.
   - Water hardness tests?

Question 3

1. Duration of stage 1 labour?
2. What does stage 1 labour involve?
3. What should be done during this time?

Answer 3

1. 1-4hrs.
2. Onset of uterine contractions.
   Mild colic signs.
   Foal enters the pelvis.
   Cervix opening.
3. Prepare for foaling:
   - Bandage tail and wash perineum.
   - Episiotomy to reverse Caslicks if not done yet.

Question 4

1. Duration of stage 2 labour?
2. What does stage 2 labour involve?

Answer 4

1. 5-25mins.
2. Abdominal contractions.
   - explosive, powerful.
   Chorioallantoic membranes rupture.
   - at cervical star.
   Amnion exteriorised.
   Foal delivered.

Question 5

1. Presentation.
2. Position.
3. Posture.
4. Ideals for these?

Answer 5

1. Direction of foal.
2. Relative spines.
3. Limbs.
4. • Anterior presentation.
     - Dorsal position.
     - Limbs extended.

Question 6

Immediately post partum.

Answer 6

Minimal human interference ideally for foal-mare bonding.
Bring foal to mare’s head if birth assisted.
Righting reflexes present w/in 5 mins.
- foal attempting to stand.
- standing by 1hr.
- suckling by 2hrs.
- placenta passed by 3hrs.

Question 7

1. Duration of stage 3 labour.
2. What happens in stage 3 labour?
3. What if stage 3 labour >3hrs.

Answer 7

1. 3hrs.
2. Expulsion of foetal membranes.
   - allantochorion.
   - lochia.
   Mild uterine pain.
3. Foetal membranes considered retained.

Question 8

Post partum.

Answer 8

Uterine involution rapid.
Vulval discharge 3-4d.
Turnout helps express lochia.
Foal heat 5-9d - breed on foal heat?

Question 9

1. Circumstances for inducing parturition.
2. How to induce.

Answer 9

1. IN HOSPITAL.
   - Rupture pre-pubic tendon.
   - Hydrops uteri.
   - Overdue and small foal.
   - Uncomfortable and open cervix.
2. Low dose oxytocin.
   - 10 i.u. every 20mins.
   - OR daily oxytocin when imminent.
   PG cervix.
   More risk to foal than to mare.

Question 10

Premature placental separation.

Answer 10

“red-bag delivery”.
Predisposed by induced labour.
This is an emergency and foal needs to be delivered ASAP.
Foal supplemental O2.
High risk perinatal asphyxia syndrome - “dummy foal”.

Question 11

1. Maternal causes of dystocia?
2. Foetal causes of dystocia?

Answer 11

1. Uterine torsion.
   Pelvic fracture.
2. Size.
   Malpresentation.
   Deformities:
   - hydrocephalus.
   - limbs.

Question 12

Dystocia - taking the call.

Answer 12

Advise Os keep mare walking and put on tail bandage.
Drive directly and immediately OR get mare to hospital ASAP.
- Foal at risk of perinatal asphyxia syndrome and/or hypoxia.
Most of the time, a live foal will be there when you arrive.
- 1-4% incidence dystocia in thoroughbreds.
- 10% incidence in drafts.

Question 13

When is it considered equine dystocia?

Answer 13

No amnion or foal at vulva w/in 5mins of allantochorion rupturing (water breaking).
No strong contractions w/in 10mins of allantochorion rupturing (water breaking).
VAGINAL EXAM INDICATED IMMEDIATELY!

Question 14

1. Dystocia options.
2. Choice of option determined by…

Answer 14

1. Vaginal assisted delivery.
   Controlled vaginal delivery.
   C section.
2. Cost
   Live foal/dead foal.
   Owner.
   Vet.

Question 15

1. Vaginal assisted delivery suitable for?
2. Experience w/ what helps immensely?
3. Rules for when to refer.
4. Principles.
5. Method?

Answer 15

1. Quick fix on stud / yard.
   Suitable for:
   - red bag delivery.
   - some abnormal presentations.
   - economic challenges???
2. Experience w/ lambing / calving helps immensely.
3. Consider how long to try for.
   Keep making progress, stopping and reassessing.
   REFER if no progress in 5 mins OR if not out in 30mins.
4. +/- sedate mare.
   Maintain hygiene.
   LUBRICATION!
   Clenbuterol.
   Consider epidural.
5. ID fore/hindlimbs.
   Rope limbs - to pull on.
   Rope head - to guide position, NOT pull.
   Pull DOWNWARDS.
   Pull in synchrony w/ uterine contractions.
   Need foal catchers if standing.

Question 16

Controlled vaginal delivery.

Answer 16

Deliver foal per vaginum.
Mare is anaesthetised.
Elevate HLs.
Allows repositioning w/o contractions impairing progress.

Question 17

Indications for episiotomy.

Answer 17

If Caslicks’ previously performed:
- reverse (incise) ~2w before birth.
– when udder develops.
– Daily Vaseline.
- if appalling conformation:
– few large sutures easy to remove.
If large foal - incise 1 or 11 o’clock.

Question 18

1. Surgical options.
2. Fostering.

Answer 18

1. C section and embryotomy.
   2 Pick a good mum.
   TB mares not easy.
   Camouflage smell of new foal.
   - Vicks on nose.
   - Dead foal skin as a coat.
   Ensure agreement between O of foal and O of mare - who pays for what.

Question 19

Dystocia after care.

Answer 19

Foal:
- standing w/in 1hr.
- suckling w/in 2hrs.
Closely monitor mare for:
- DUDE.
- Lactation - Tx Domperidone.
- Pain - Tx NSAIDs.
- Passing placenta w/in 3hrs.
- Laminitis.
- Endotoxic shock.
- Peritonitis.

Question 20

Post partum problems.

Answer 20

RFM.
Trauma to vulva, vestibule, vagina, cervix, perineum, uterus, rectum, anus.
Uterine rupture / haematoma / prolapse.
Rupture utero-ovarian artery.
Hypocalcaemia.
Metritis.
Mammary gland issues.

Question 21

1. Incidence of RFM.
2. What should be done if foetal membranes are hanging out of the mare?
3. RFM Tx options.

Answer 21

1. 2-10% (50% post c section).
2. Fold up and tie.
   - not weighted.
   - can be assessed afterwards.
3. Oxytocin drip/bolus.
   Manual traction W/ CARE!

Question 22

1. Actions for post removal of the RFM.
2. What are the consequences of unidentified/untreated RFM?

Answer 22

1. Lavage large volume.
   Oxytocin bolus.
2. Endometritis.
   Laminitis.
   Shock.
   Death.

Question 23

1. First degree perineal laceration.
2. Second degree perineal laceration.
3. Tx of these.
4. Third degree perineal laceration.

Answer 23

1. Vulval lips.
2. Vulval lips and muscle layers.
3. Usually too swollen to suture immediately:
   - delay repair until swelling subsided.
   - resolve problem before covering.
   - MISS FOAL HEAT.
4. Recto-vaginal fistula.

Question 24

Cervical trauma.

Answer 24

Rare but serious consequence for future fertility.
Assess using speculum in dioestrus.
Fibrosis leading cervical incompetence.
Full thickness tears sutured 4-8wks.
Warn O of potential poor fertility.

Question 25

Uterine tear/rupture management.

Answer 25

Manage conservatively if dorsal and small. Considered surgical emergency if large/ventral - important to recognise costs!

Question 26

1. Uterine haematoma presentation. 2. Uterine haematoma Dx. 3. Uterine haematoma healing. 4. Presentation of ruptured ovario-uterine artery? 5. Dx of ruptured ovario-uterine artery? 6. Tx of ruptured ovario-uterine artery?

Answer 26

1. Presents as post partum colic. 2. Rectal palpation and US. 3. Usually w/o complication. 4. Severe colic. 5. On clinical signs and US. - Abdo paracentesis. 6. Autotransfusion/blood transfusion. ? Formalin IV Antifibrinolytics (aminocaproic acid).

Question 27

Uterine prolapse.

Answer 27

Rare and diagnosed by presentation. Fatal haemorrhage possible. Lavage thoroughly. Feed back in gently and lavage large volume of fluid. Treat w/ ABX, NSAIDs, calcium, NO oxytocin.

Question 28

1. Hypocalcaemia related to? 2. Presentation of hypocalcaemia? 3. Tx of hypocalcaemia. 4. Predisposes mare to what?

Answer 28

1. Stress. 2. Hyperaesthesia and dry faeces. Spontaneous diaphragmatic flutter (Thumps). Recumbency and tetanic spasms. 3. Infuse Ca borogluconate. 4. Post partum colic.

Question 29

1. Risks associated w/ metritis. 2. Metritis Tx. 3. Mammary gland problems.

Answer 29

1. Poor fertility, laminitis, endotoxaemia. 2. Copious lavage. Topical +/- systemic ABX. NSAIDs. Polymixin B. 3. Agalactia. Mastitis. Premature lactation.

Question 30

1. What mares tend to have agalactia 2. Mechanisms of agalactia. 3. How can agalactia be dx by serum? 4. Tx of agalactia.

Answer 30

1. Primiparous mares. 2. Ingestion ergot alkaloid. Poor nutrition. Pain. 3. Serum prolactin decreases. 4. Domperidone, Metaclopramide.

Question 31

Mastitis.

Answer 31

Can also occur in non-breeding mares. O may think lame. Hot, swollen, painful. May show systemic signs. Diagnose by presentation and milk cytology / culture (usually streptococcus zooepidemicus).

Question 32

1. Mastitis Tx. 2. What should you check in the case of premature lactation? 3. What should be done in the case of premature lactation?

Answer 32

1. Milk out. Intramammary preparations (cows). Hot pack. NSAIDs. Systemic ABX - TMPS / Penicillin. 2. Combined thickness of uterus and placenta for placentitis. 3. Collect colostrum and store in fridge to stomach tube foal.

Question 33

1. Critical mare-foal bonding period? 2. Risks of foal rejection. 3. Why may mare reject foal? 4. Management and Tx.

Answer 33

1. 1st 6hrs of foal life. 2. Failure of passive transfer +/- trauma to foal. 3. - Maiden mare. - Mare reared in isolation. - Arab mare. - Painful mare (mammary glands?) 4. Don't punish mare. Give aggressive mare atrenogest. NSAIDs. Oxytocin. Hand milking. Sedation w/ ACP.