Week 8- Post Partum Problems in the mare

Question 1

What are considered to be retained foetal membranes?

Answer 1

• 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

Question 2

What is the clinical presentation of retained foetal membranes?

Answer 2

• placental tissue protruding from the vulva
• examine placenta post-partum
• if torn- use vessels to assess whether a portion is missing

Question 3

What happens if RFM is prolonged?

Answer 3

• metritis
• endotoxaemia
• laminitis

Question 4

How might you treat RFM?

Answer 4

membrane hanging in hocks or below
* tie in a knot
* encourage passage and reduces trauma

Question 5

What happens if RFM is retained for 2 hours?

Answer 5

give low dose oxytocin IM hourly

Question 6

What do you do if RFM for 6 hours?

Answer 6

• 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

Question 7

What are the three options for RFM further therapy?

Answer 7

• 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

Question 8

How would you catheterise the umbilic vessel?

Answer 8

• through a foal NG tube
• placenta passes within 5-10 minutes

Question 9

What medication is used if retained for over 6 hours?

Answer 9

• systemic antibiotic s
• NSAIDS
• Laminitis support- cryotherapy

Question 10

What is the prognosis for RFM?

Answer 10

Excellent if treated appropriately

Question 11

What is metritis and when does it present?

Answer 11

• low incidence
• presents with birth trauma
• presents 2-4 days PP
• inflammation of the uterine wall permits bacteria

Question 12

What is the clinical presentation of metritis?

Answer 12

• Signs of endotoxaemia
• fever, anorexia, tachycardia, congested MM
• laminitis
• Vaginal discharge
• pronounced neutropenia

Question 13

How might you treat metritis?

Answer 13

• Broad-spectrum antibiotics
• NSAIDS
• IV fluid
• oxytocin
• uterine lavage
• broad spectrum uterine antibiosis
• prevent/ treat laminitis

Question 14

Why may vulval trauma occur?

Answer 14

• failure to open caslick
• large foal size

Question 15

When do perineal lacerations occur?

Answer 15

• maiden mares
• malpresentations
• normal foaling…

Question 16

What is a first degree perineal laceration?

Answer 16

• vulval lips
• dorsal vulval commisure
• may heal spontaneously if mild
• repair using caslicks if bigger

Question 17

What is a second degree perineal laceration?

Answer 17

• mucosa, submucosa of vestibule
• often impairs vestibulo-vulval seal
• generally requires surgical repair
• healthy granulation tissue needs to be present for repair

Question 18

What is a third degree perineal laceration?

Answer 18

• all layers of the vestibule
• faecal contamination
• can involve cranial tissues
• peritoneal contamination
• Antibiotics, NSAIDS, LAXITIVES

*

Question 19

What is the surgical repair for a third degree PL?

Answer 19

• assess after secondary intention healing
• laxatives
• sedate and epidural
• reconstrcut vaginal roof

Question 20

What is the most common cause of recto-vaginal fistula?

Answer 20

foal foot penetration

Question 21

What is urovaginum?

Answer 21

• cranial displacement of vagina and urethral orifice
• cervicitis
• scald
• constant urine discharge
• usually resolves spontaneously

Question 22

How would you treat urovaginum?

Answer 22

• urethral extension surgery if it persists

Question 23

What is peri-parturient haemorrhage?

Answer 23

• rupture of middle uterine artery
• 40% of mare deaths after foaling
• risk of haemorrhae increases in older mares with multiple foals

Question 24

What happens with a uterine artery bleed?

Answer 24

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

Question 25

What happens with a vulvar bleeding?

Answer 25

➢ Associated with trauma to uterine or vaginal vessels ➢ A haematoma here may present as a large unilateral vulvar swelling

Question 26

What is the clinical presentation of a per-parturient haemorrhage?

Answer 26

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

Question 27

How might you diagnose a peri-parturient haemorrhage?

Answer 27

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

Question 28

What are the two main treatments of peri-parturient haemorrhage?

Answer 28

* Shock therapy * Conservative therapy

Question 29

What is shock therapy?

Answer 29

* IVFT → Hypertonic saline followed by isotonic fluids * Supplemental oxygen * If PCV <15 = Whole blood transfusion

Question 30

What is conservative therapy?

Answer 30

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

Question 31

What are the three additional therapies for peri-parturient haemorrhage?

Answer 31

* Transexaemic acid * Formalin * Naloxane

Question 32

What are the clinical signs of uterine laceration?

Answer 32

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

Question 33

How might you diagnose uterine laceration?

Answer 33

Digital palpation ➢ challenging – tear may be small or out of reach * Abdominocentesis ➢ Septic peritonitis * Haematological changes ➢ infection

Question 34

How might you treat uterine laceration?

Answer 34

Small laceration ➢ Medical Treatment * Broad spectrum antibiotics * Flunixin * Oxytocin * IVFT * Large laceration ➢ Surgical repair

Question 35

How might you treat a uterine prolapse?

Answer 35

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

Question 36

What medications would you use for a uterine prolapse?

Answer 36

* Broad spectrum antimicrobials * NSAIDs e.g flunixin * Oxytocin ONLY once replaced→ increase uterine tone * Fluid therapy if required

Question 37

What would you do if the uterine horn tip has been inverted?

Answer 37

Mild to severe colic * Rectal palpation → short, thickened uterine horn * Tx: Manual reduction & infusion of saline into uterus

Question 38

How might you treat hypogalactia?

Answer 38

* * Good nutrition * Oxytocin to enhance milk let down * Domperidone (dopamine antagonist) ➢ Twice daily 2-4 days ➢ Once daily 6-8 days