Post-Partum Problems - Mare Flashcards
(30 cards)
Causes of Dystocia/ Foaling Trauma:
- Vestibular/vulval trauma
- Urovaginum
- Rupture of cervix/vagina
- Perineal lacerations
- Recto-vaginal fistula
- Rectal prolapse
- Uterine rupture
- Uterine haematoma
- Uterine prolapse
- Invagination of the uterine horn
- RFM
Causes of Non-Traumatic Conditions:
- RFM
- Post partum metritis
- Hypocalcaemia
- Colic
Diagnostic Approach
- Hx
- Clinical exam
- Rectal palp
- Vaginal exam
- Exam placenta
RFM
- What
Not passed within 3hrs
Draft breeds - Friesians
RFM - Clinical Presentation
Placenta protruding from vulva OR no external signs
Torn - use vessels to asses portion missing
Missing portion - assume still in mare
No ill affects early
Prolonged - metritis, endotoxaemia, SIRS, laminitis
RFM - Tx:
Membrane hanging at hocks/ below
- tie in knot = encourages passage & reduces trauma
Retained >2hrs = low dose oxytocin IM hrly
Uterine lavage after removal
- Aids debris removal
- reduce bacterial load
- Stim uterine contractions
RFM - Tx >6hrs
Retained > 6hrs & oxytocin unsuccessful
- Manual removal
- Evaluate mare again
- IV Oxytocin +/- sedate
- Tail bandaged & perineum cleaned
- Gentle traction on allantochorion
- Slide hand between endometrium & allantochorion
Systemic Abs +/- intrauterine - TMPS or pen & gent
NSAIDS
Laminitis support - frog support & deep bed +/- cryotherapy
RFM - Further Therapy
- Allantochorion twisted to separate from endometrium
- Allantochorion distended
- 12L 0.1% iodine in saline
- Clean nasogastric tube
- Tied w umbilical cable
- Fluid maintained for 30mins before expulsion - Umbilical vessel catheterised & infused w water
- via foal NG tube or stallion catheter
- Placenta passed in 5-10 mins
Metritis – What
Low incidence
Increases w birth trauma, RFM
2-4d post partum
Inflamed uterine wall = bacteria & toxins enter systemic circ
-> Bacteraemia & endotoxaemia
Metritis - Clinical Signs
Endotoxaemia / SIRS
- Fever, anorexia, tachycardia, congested mucus membranes, dehydration
+/-laminitis
Malodourous vaginal discharge
Large vol red-brown watery fluid
Neutropenia
Metritis - Tx
Broad spec Abs = Pen & gent
NSAIDS = flunixin
IVFT
Oxytocin IM q 4-6hrs
SID/BID large vol uterine lavage
- 0/9% saline
- 0.1% iodine solution = 1st lavage
- Repeat until fluid free from gross contam
Broad spec intrauterine ABs
Prevent/ tx laminitis
- frog supports, deep bed, stall confinement, cryotherapy
Vestibular/ Vulval Trauma
Unavoidable
Swelling resolves in 2ds
Tears from
- not opening caslick
- large foal
Sutures ~ necessary
- Immediate - min swelling
- Delayed - bruising/ oedema severe
Perineal Lacerations
1st degree
Vulval lips (skin & mucus membranes)
Dorsal vulval commissure
Mild- heal spontaneously
- Clean daily w warm water & antiseptic cream
Bigger = repair w caslick
- swelling = wait 2-4ds
Perineal Lacerations:
2nd Degree
- Mucosa, submucosa of vestibule, the dorsal vulva and some perineal muscle
- Often impair vestibulo-vulval seal
➢ -> pneumovaginam - Surgical repair
➢Only after inflammation and swelling have
subsided (weeks)
➢Healthy granulation tissue needs to be present for repair
Perineal Lacerations
3rd Degree
- All layers of the dorsal vestibule, perineal body, caudal rectal floor and external anus
➢Faecal contamination of caudal reproductive tract
➢Usually dorsal deviation of foal foot - Usually retroperitoneal
➢Possible peritoneal contamination if more cranial
Immediate Tx:
- Abs, NSAIDs, laxatives
Surgical Repair:
* Asses after 2nd intention healing (4-6 weeks)
* Laxative/manual removal of faeces post-surgery
* Sedate and epidural (standing)
* Reconstruct vaginal roof and rectal floor
* Caslick suture to close vulval lips
Perineal Lacerations
Recto-vaginal Fistula
- Foal foot penetration
Detected
* Palpation
* Vaginal expulsion of faeces
Treatment
* No spontaneous resolution
* Surgical repair – as for 3rd degree perineal laceration
Urovaginum:
- Cranial displacement of vagina and urethral orifice over the pelvic brim
- Urine pools in cranial vagina
- Cervicitis / vaginitis / urometra / urine
- scald
- Constant urine discharge (incontinence?)
- Usually resolves spontaneously w/i 2 weeks as tract involutes
Treatment
* Symptomatic
* Urethral extension surgery if persists
Peri-Parturient H+:
What
- Rupture of middle uterine artery
➢Also utero-ovarian arteries, external iliac arteries - 40% of mare deaths after foaling due to uterine artery rupture
- Risk of h+ increases in older mares that have had multiple foals
➢Atrophy and fibrosis in arterial wall
Peri-Parturient H+:
Uterine Artery Bleeds
➢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
Peri-Parturient H+:
Vulvar bleeding
➢Associated with trauma to uterine or vaginal vessels
➢A haematoma here may present as a large unilateral vulvar swelling
Peri-Parturient H+:
Clinical Presentation
- Dependant on location and degree of haemorrhage
- Vulval bleeding→very little signs of discomfort
- In broad ligament or uterine or pelvic wall
➢signs of colic
➢Painful stretching of the tissues - If artery ruptures into peritoneal cavity
➢May not be painful but haemorrhage profuse and rapidly fatal
H+ Signs:
- Sweating
- Muscle fasciculations
- Mins - hypovolaemic & hypotensive shock
- - Pale MM
- Haemabdomen
- Tachycardia
- Lethargy
Peri-Parturient H+:
Diagnosis
- 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
Peri-Parturient H+:
Treatment
- Keep mare quiet → prevent clot disruption
Shock therapy
* IVFT→Hypertonic saline followed by isotonic fluids
* Supplemental oxygen
* If PCV <15 = Whole blood transfusion
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
- Tranexamic acid
➢Anti-fibrinolytic : aid in clot stabilisation
➢10mg/kg by slow iv injection up to 3 times in first 24 hours - Formalin
➢Induce primary haemostasis
➢Enhanced endothelial or platelet activation
➢16ml of 10% buffered formalin diluted in 45 ml 0.9% saline given once slowly iv - Naloxone
➢Inhibits action of endogenous opioids ➢Helps decrease vasodilation
UTERINE LACERATION
Clinical SIgns
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
