The peripartum mare: abdominal wall defects, hemorrhage and retained fetal membranes Flashcards
(34 cards)
Describe abdominal wall defects in mares.
- Rupture of ventral body wall
- Rupture of prepubic tendon
- May occur in Late gestation
- Draft breeds are predisposed
Risk factors:
* Older mare
* Twins
* Hydrops
* Ventral edema
* History of abdominal trauma
Clinical signs of abdominal wall defect in the mare.
- Rapidly growing ventral edema
- Pain on palpation
- Colic
How to differentiate from GI colic?
Differentiate by Abnormal abdominal contour and Abdominal swelling.
Signs of Prepubic tendon rupture: (4)
- Reluctance to walk
- Udder displaced cranioventrally
- Pelvis tilted cranioventrally
- Bloody mammary secretion
Diagnostics for abdominal wall defect in the mare involve: (3)
- History/anamnesis
- Clinical signs (the obvious abdo contour)
- Transabdominal U/S
Treatment of abdominal wall defect in the mare.
Partial tear or rupture:
* Stall rest
* NSAIDS
* Supportive bandage/wrap
Preterm delivery should be done to get excess weight and pressure off the tear but C-section is not immediately recommended unless:
* its an Emergency
* or full-term fetus
Complications of abdominal wall defect in the mare. (4)
- Recumbency
- Rupture of large blood vessels
- Uncontrollable pain
- Death
Prognosis after abdominal wall defect in the mare.
With conservative management; Fair to good.
Preterm delivery of the foal; Poor prognosis. (preemie foals just don’t make it very often)
Rebreeding is not reccomended cause it can tear again.
Describe Hemorrhage in the peripartum mare.
Occurrence
* Mid-to late gestation
* During parturition
* Immediately after parturition
* Several days after parturition
Usually Older, multiparous mares but can affect Mares of any age and parity really.
Periparturient hemorrhage can be cause by
- The Uterine artery
- Iliac, utero-ovarian, pudendal or vaginal artery
- Ovarian vessels
The Bleeding can also be into an internal lumen:
* Peritoneal cavity
* Broad ligament
* Serosal layers of the uterus
* Lumen of the uterus
Clinical signs of peripartum hemorrhage (since it might not be hemorrhaging outside the body).
Colic signs:
* Lethargy
* Pawing, rolling, discomfort
* Cold sweating
* Flehman response
* Tachycardia, tachypnea
- Pale mucous membranes, CRT>2sec
- Muscle twitching/fasciculation
- Weakness, ataxia
- Occasional vocalization
- +/- bloody vulvar discharge
Sometimes signs are absent and you just get Sudden death.
Diagnosis of peripartum hemorrhage, main points: (2)
Analgesia and Safety first!
Sedation
* Xylazine 0,25-1mg/kg IV or IM
* Detomidine 0,01-0,04mg/kg IV or IM
* Butorphanol 0,02mg/kg IV or IM
Do not use acepromazine! causes hypotension.
Analgesia
* Flunixin meglumine 1,1mg/kg IV
* Butorphanol 0,02mg/kg IV or IM
Physical examination and Complete blood count, biochemistry of a hemorrhaging mare may show:
Mucous membranes (colour, CRT) Color may still be normal in acute phase.
Cold sweat on Lateral neck, dorsal thorax, legs.
Anemia, hyperlactactemia, hypoproteinemia, azotemia (urea, creatinine).
Diagnosis of hemorrhage using Transabdominal U/S and rectal palpation/ultrasound.
Transabdo:
* Free fluid (blood) (Looks like Hyperechoic particles swirling within anechoic fluid)
* Uterus and broad ligament may feature hematomas.
Rectal palpation/US
* Be careful! Only when it’s safe for the mare!
* Hematomas may be palpated
* Blood in uterus may be palpated
Vaginal examination may yield Uterine bleeding.
Abdominocentesis for diagnosing hemorrhage in the peripartum mare.
- You get Red fluid that doesn’t clot.
- PCV of 8-20%
- Absence of platelets
When bleeding occurs, platelets rapidly aggregate at the site of vascular injury to form a clot. This means that free platelets are consumed at the site of hemorrhage, leading to a lack of platelets in the surrounding fluid.
Treatment of hemorrhage in the peripartum mare. (5)
Conservative treatment, or Rapid and aggressive treatment in stable but Transfer to hospital after stabilizing the mare.
- Box-rest
- Quiet and calm environment
- Keep the foal with mare If not dangerous to the foal.
Control pain and anxiety:
* NSAIDS: flunixin
* Opioids: butorphanol
* Alpha2-agonists: detomidine
Fluid therapy
* Rapid rise in blood pressure could disrupt clotting so be careful with fast fluids.
* 10-20L/500kg Ringer, NaCl 0,9% bolused IV
Blood and plasma transfusion
* For Severe, persistent hemorrhage.
* In hospital setting only.
* Indicated when PCV < 12-15%.
Hemostatic treatments.
If responding to treatment, HR, stronger peripheral pulses, improvement of mucous membrane color, warming of extremities, less anxious. Stabilizes within 60min after treatment. If not, Condition worsens and it May die.
Hemostatic treatments for horses. (3)
Tranexamic acid 5-25mg/kg IV, IM, SQ q 12h
Aminocaproic acid
* Inhibits fibrinolysis, stabilizes clot formation.
* 40mg/kg diluted in 1L isotonic fluids, given over 20min IV.
* Repeat 10-20mg/kg in 1L isotonic fluids every 6h.
Chinese herb Yunnan Baiyou
* Proven for blood vessel constriction, platelet and clotting factor and anti-inflammatory.
* Dissolve 8mg/kg in 20ml of lukewarm water,
give PO q 6h, 3-4days.
If responding to treatment, HR, stronger peripheral pulses, improvement of mucous membrane color, warming of extremities, less anxious. Stabilizes within 60min after treatment. If not, Condition worsens and it May die.
Antibiotics for post-Treatment of hemorrhage in the peripartum mare. (2)
Used To prevent:
* Abscessation of large hematomas
* Secondary infections (blood in cavities is ideal media for bacterial growth).
Try Penicillin+gentamicin
* Procaine pen. 22000 IU/kg IM BID + genta 6,6mg/kg IV SID
* Potassium pen 22000 IU/kg IV BID QID + genta 6,6mg/kg IV SID
Or TMS
* 30mg/kg PO BID
* 20mg/kg IV BID (slowly)
Aftercare for mares after peripartum hemorrhage.
- Stall rest at least 2 weeks
- Suggest not to breed in this season
If owner still wants to rebreed
* Transrectal U/S at 30 days postpartum to Make sure hematoma is well organized and consolidated.
* Warn the owner about the higher risk of bleeding during pregnancy.
Mares can remain fertile, ~50% of mares produced one or more foals after recovery.
Retained fetal membranes are
Partial or complete failure of expulsion of chorioallantois.
- They count as retained when Not passed within 3 hours of foaling.
- Is an Emergency!
Can cause Life threatening complications such as
* Toxic metritis
* Laminitis
* Peritonitis
Prevalence of 2-10% in all breeds. Up to 54% draft breeds.
Physiology of expulsion of fetal membranes.
- Release of the allantochorion.
- Rupture of umbilical cord with collapse of the placental blood vessels.
- Microvilli shrink and slide out of endometrial crypts.
- Endogenous oxytocin causes rhythmic contractions of the uterus Starting from the tips of the horns to cervical opening starting with the Pregnant horn first.
- The fetal membranes Invaginate and pass through the ruptured cervical star so that they are expulled inside out.
- When passed through vulvar opening the Increased weight pulling results in Release of nonpregnant horn.
Normally the membranes are Intact, shiny gray allantoic surface outermost with Remnants of umbilical cord and amnion attached.
The etiology of why placenta can retain.
- Not fully underestood
- Uterine inertia suspected.
- Low calcium
- Overstreching of myometrium
- Myometrial exhaustion e.g. due to dystocia.
- Or a hormonal imbalance
Risk factors for retained fetal membranes in the mare. (5)
- Placentitis
- Abortion
- Preterm delivery
- Induced foaling
- Dystocia and Cesarian section (these might come with Uterine inertia, Endometrial inflammation and hemorrhage)
Clinical signs of retained fetal membranes. (4+)
- Fetal membranes protruding through vulvar labia.
- No fetal membranes to be found.
- Only Partial fetal membranes found.
- 24-48h after foaling Dark, stinking vaginal discharge
Signs of endotoxemia:
* Depression
* Pyrexia
* Inappetence
* Tachycardia
* Injected mucous membranes
* Reduced milk production
Describe diagnosis of retained fetal membranes by
thorough examination of the chorioallantois:
If something has come out, lay it out in the shape of F. Check for:
* Ruptured cervical star at the base
* 2 horns forming the arms
* Allantoic surface first (should be Shiny, grey)
* Check the Tips of the horns
* Pregnant horn should be edematous
* Nonpregnant horn thinner, more folded up.
* Check the Chorionic surface (should be Red, velvety) also Scarring and thickening.
When the membranes seem to be too damaged,
* Assume that something is retained.
