Caecal rupture in parturient mares

[Morbidity and mortality of mare and foal following dystocia - a literature review]

Dystocia represents a life-threatening condition for mare and foal. Morbidity and mortality rates due to a difficult birth, as well as the influence on fertility of the mare were analyzed, based on a review of publications. This was aggravated by the fact that no standardized diagnostic code was used and that most publications do not clearly describe how extensively the examinations were performed beforehand. Retentio secundinarum is the most common complication caused by dystocia. Other complications are injuries to the soft birth canal and the colon. These occur more frequently after surgical obstetrics than following assisted vaginal deliveries. Performing a fetotomy increases the risk of injury to the birth canal. After a caesarean section, the risk for retained placenta increases significantly. In order to evaluate the possibility of medical progress over time, mortality rates of mare and foal were investigated and divided in surgical and conservative obstetrics within the period of 1970-1990 and 1991-2021. The average maternal mortality rate following caesarean section amounted to 18% in the time period between 1970 and 1990 and 14% between the years from 1991-2021. After fetotomy, the two determined mortality rates amounted to 29% and 10% for the time between 1970 and 1990. In the period 1991-2021, the rate varies between 4% and 44% with an average mortality rate of 14%. Following controlled vaginal delivery, the average mortality rate is 9%. Literary sources were however only available for the current time period and range between 6% and 29%. The morbidity and mortality rate of foals is very high. Following caesarean section on average 53% of foals are dead on delivery, with a range of 13-79% in case reports from the years 1991-2021. The number of dead foals in the context of conservative obstetrics is of a similar scale. Postnatal foal diseases are largely due to intrapartum hypoxia during dystocia and obstetric injury. In consequence of a difficult delivery, mares experience reduced fertility. In numerous cases this however may be compensated by pausing from further breeding in the same year. The number of cases evaluated in this context however remains too small to advocate any recommendations for breeding following incidents of dystocia.

Peritoneal fluid analysis in equine post-partum emergencies admitted to a referral hospital: A retrospective study of 110 cases

BACKGROUND

Peritoneal fluid analysis has both diagnostic and prognostic value in colic but is little reported in the post-partum mare. Multiple conditions may present similarly in this period, and peritoneal fluid findings may aid a prompt diagnosis.

OBJECTIVES

To describe the peritoneal fluid findings and their association with diagnosis in mares presenting to a single referral hospital for treatment of postpartum emergencies.

STUDY DESIGN

Retrospective clinical study.

METHODS

Clinical records of 110 Thoroughbred mares were reviewed. Details of peritoneal fluid analysis from samples obtained at admission were recorded, in addition to history, physical examination, presenting clinicopathological data. Cases were classified by their primary diagnosis into groups of gastrointestinal tract (GIT), urogenital trauma (UGT) and post parturient haemorrhage (PPH). Univariable analysis was performed to compare findings between groups, using one-way ANOVA and post hoc Tukey/Kruskal Wallis, as appropriate. Multinomial logistic regression was performed for variables significant in the univariable analysis.

RESULTS

When separated into their diagnostic categories, 33/110 (30%) mares were classified as GIT, 55/110 (50%) UGT and 22/110 (20%) PPH. Peritoneal fluid packed cell volume (PCV), nucleated cell count (WBCC) and cytological findings were significantly different between diagnostic categories. The likelihood of diagnosis of PPH increased with an increase in peritoneal fluid PCV, the absence of degenerate neutrophils on peritoneal fluid cytology and a decrease in the peritoneal fluid WBCC. Overall survival to discharge was 55%.

MAIN LIMITATIONS

Referral hospital-based study and retrospective nature. Missing data reduced power of analysis for several variables.

CONCLUSIONS

Peritoneal fluid analysis may guide diagnosis in postpartum emergencies, but no one factor is uniformly diagnostic. Mares with PPH presented with a non-septic peritonitis with higher peritoneal PCV.

Managing Reproduction Emergencies in the Field: Part 2: Parturient and Periparturient Conditions

Selected conditions affecting broodmares are discussed, including arterial rupture, dystocia, foal support with ex utero intrapartum treatment, uterine prolapse, postpartum colic, the metritis/sepsis/systemic inflammatory response syndrome complex, and retained fetal membranes. Postpartum colic beyond third-stage labor contractions should prompt comprehensive evaluation for direct injuries to the reproductive tract or indirect injury of the intestinal tract. Mares with perforation or rupture of the uterus are typically recognized 1 to 3 days after foaling, with depression, fever, and leukopenia; laminitis and progression to founder can be fulminant. The same concerns are relevant in mares with retention of fetal membranes.

[Incidence of puerperal diseases during the first 10 days after foaling in the mare]

OBJECTIVE

The aim of this study was to evaluate the frequency of puerperal diseases in breeding mares in the first 10 days after birth by analysing patient data.

MATERIAL AND METHODS

In a university clinic patient data of 308 breeding mares with puerperal disorders which presented within the first 10 days postpartum were evaluated over a period of 10 years. A distinction was made between diseases which were able to be diagnosed at the first examination and diseases which developed during the patient's stay in the clinic.

RESULTS

A total of 21 diseases were diagnosed, with a retained placenta, lochiometra and injuries to the perineum being the most common. Many mares displayed more than one disease. Mares with a retained placenta most commonly also presented with perineal ruptures, followed by animals who also had lochiometra. Mares suffering from lochiometra commonly presented together with a retained placenta and injuries as a result of birth. Some of the mares developed further diseases. In mares with a retained placenta, this was most commonly lochiometra, followed by puerperal laminitis and thrombophlebitis.

CONCLUSION AND CLINICAL RELEVANCE

The data collection shows that several diseases could relatively frequently be diagnosed in mares with puerperal disorders. Therefore, a higher percentage of further diseases must be assumed for mares which have a puerperal disease.

Critical peripartum disease in the mare

The variety of diseases that occur in the peripartum mare require the examining veterinarian to evaluate the patient and the historical information carefullly so as to make an accurate diagnosis and begin appropriate therapy. An understanding of equine behavior, reproduction. mechanisms of shock,and gastrointestinal and reproductive physiology is requisite for accurate interpretation of the myriad of clinical signs of diseases present in this population. Attention to the unique metabolic and physiologic needs of the pregnant and lactating mare can aid the critical care clinician in providing optimum supportive care to enhance convalescence and improve outcome in the these critical patients.

The effects of parturition and peripartum complications on the peritoneal fluid composition of mares

Abnormalities in peritoneal fluid are diagnostically useful for managing equine colic; however, their significance in post-dystocia mares is not known. This study was to determine what changes, if any, occurred following obstetrical manipulations. Peritoneal fluid samples were collected from 2 groups of foaling mares to establish control values, and from a third group that had developed clinical abnormalities (CAb,n = 14) or had made an uneventful recovery (CN,n = 36) following fetal extraction. In Group 1 mares, samples were collected before and after induced parturitions (n = 7), and although the total nucleated cell count was increased (P < 0.02) the median values for peritoneal fluid composition remained within the normal reference range. In Group 2 mares, samples were collected after unassisted foalings (n = 10) on postpartum Days 1, 3, 5 and 7, and the peritoneal fluid values remained within the normal reference range. In the Group 3 (CN) mares neither assisted vaginal delivery or fetotomy caused median peritoneal fluid values to rise above the normal reference range. Although remaining within normal limits, the total nucleated cell count was increased (P < 0.01) on Day 2. The median peritoneal fluid total protein value for Group 3 (CAb) mares was greater than the median value for Group 3 (CN) mares on Day 1 (P < 0.05) and Day 2 (P < 0.001). The peritoneal fluid total nucleated cell count in Group 3 (CAb) mares with a uterine tear, vaginal laceration involving the peritoneal cavity, or a ruptured mesocolon was greater than in Group 3 (CN) mares (P < 0.02). The median peritoneal fluid percentage of neutrophils value for Group 3 (CAb) mares was higher than for Group 3 (CN) mares on both Days 1 and 2 (P < 0.02). Elevation of a single peritoneal fluid value in the postpartum mare may be incidental; however, increases in 2 or more of these (total protein > 3.0 g/dl; total nucleated cell count > 15,000 cells/microl; percentage of neutrophils > 80%) is clinically significant.

Caecal disease in equids

OBJECTIVE

To review the breed, age, gender, clinical and laboratory findings, treatment and outcome of horses with caecal disease presented to a referral centre.

DESIGN

Retrospective study of 96 cases.

PROCEDURE

The breed, age, and gender of the study population were compared with the corresponding hospital population for the same period. The means (+/- SD) for clinical and laboratory findings were recorded for each caecal disorder. Treatment was categorised as medical or surgical, and outcome was recorded.

RESULTS

Caecal diseases included impaction (40% of total cases), rupture associated with concurrent unrelated disease (13%), rupture with parturition (9%), rupture with no associated disease (5%), infarction (11%), torsion (9%), abscess or adhesion (7%), tumour (3%), and miscellaneous conditions (3%). The breed or gender of affected horses did not differ from the hospital population, although horses > 15 years were more frequently represented (P < 0.05). This age group was specifically more predisposed to caecal impaction (P < 0.05), as were Arabian, Morgan, and Appaloosa breeds (P < 0.05). In horses with caecal impaction transrectal examination was the most useful diagnostic procedure; 90% of affected horses treated medically were discharged while horses treated by typhlotomy alone, or typhlotomy and blind end ileocolostomy, had survival rates to discharge of 71% and 86%, respectively. Horses with caecal rupture associated with concurrent un-related disease showed no signs of impending rupture; all were receiving phenylbutazone, all were euthanased, and 50% had caecal ulceration at necropsy. Of horses with caecal rupture with parturition 56% had prior dystocia; in two-thirds the site of rupture was the ileocaecal junction and all were euthanased. Horses with caecal rupture with no associated disease died or were euthanased; rupture was idiopathic. Horses with caecal infarction usually had signs of abdominal pain and abdominal fluid changes consistent with peritonitis; transrectal examination was nonspecific, and typhlectomy was successful in seven of eight horses. Horses with caecal torsion had signs of severe, acute abdominal pain and typhlectomy was successful in three of five horses. Diagnosis of caecal adhesion or abscess was assisted by transrectal palpation in two of seven horses and surgical treatment was successful in two of five horses. A caecal tumour was diagnosed in three horses aged 20 years or older that presented with chronic weight loss. Other caecal diseases were uncommon.

CONCLUSION

Caecal disease is uncommon in equids but some specific features of the history and physical findings can alert the veterinarian to the possibility of caecal involvement in horses with gastrointestinal dysfunction. Medical or surgical therapy can be effective in horses where caecal rupture has not occurred.

Surgical diseases of the equine cecum

Cecal impaction and cecal perforation, the two most common equine cecal diseases, are thought to develop after slowing or interruption of a single progressive motility pattern, which begins in a pacemaker area near the apex, occurs once every 3 minutes, and propels ingesta from the cecum to the right ventral colon. Rectal examination in horses with cecal impaction is the most useful technique to grade the severity of the condition. Medical treatment is undertaken if the impaction is judged to be mild to moderate. Surgical correction of cecal impaction in severe cases requires a ventral midline celiotomy, and exploration reveals a large ingesta-filled cecum and relatively empty large colon. Currently, the techniques of typhlotomy with manual evacuation of ingesta, combined with a complete bypass of the cecum by use of a jejunocolostomy, is the preferred method of surgical management. The use of a cecocolic anastomosis remains a viable alternative surgical procedure. Cecal perforation (CP), a uniformly fatal disease of horses, most often develops when the subtle signs of cecal impaction are missed or are masked by the administration of nonsteroidal antiinflammatory agents. CP can occur in mares around the time of foaling and, in this form, is not associated with cecal outflow dysfunction. Surgical management of cecocecal or cecocolic intussusception is required and involves resection of the diseased portion of cecum, either with extra- or intraluminal techniques. Both the side-to-side and end-to-side jejunocecal anastomoses are useful and successful techniques for bypass of simple or strangulating lesions of the ileum.

Surgical management of foaling injuries

The great variety of pathologic conditions associated with the peripartum period in the mare emphasizes the need for close observation and evaluation of the mare's condition during this period. The temperament and strength of the mare and violence of parturition undoubtedly produce extreme intraabdominal pressures that result in (or enhance preexisting) pathologic changes. Although the exact etiology of many of these disease processes is unknown, careful observation with properly timed medical and/or surgical intervention could reduce the losses associated with the peripartum period.

Sudden and unexpected death in horses and ponies: an analysis of 200 cases

An analysis was made of the causes of death in horses and ponies over one year of age which died suddenly (Group 1) or were found dead but were considered normal when last seen (Group 2). There were 49 animals in Group 1. Thoroughbreds were overrepresented, but there were no ponies in this group. No cause of death was found in 30.6 per cent of cases and 16.3 per cent died from each of the following causes: haemorrhage in the respiratory system, central nervous system, and adverse drug reactions. Cardiovascular lesions were the cause of death in 14.4 per cent and the remaining 3.1 per cent had lesions of the gastrointestinal system. Racehorses mostly died suddenly from severe haemorrhage in various sites, particularly the thorax. In Group 2 there were 151 animals, and in 33.1 per cent no cause of death was determined. Gastrointestinal lesions were considered the cause of death in 39.2 per cent of cases and respiratory lesions killed 8.6 per cent. Lesions of both the central nervous system and cardiovascular system were considered the cause in 4.6 per cent of cases. The remaining 9.9 per cent of animals had miscellaneous lesions. Toxicological studies were performed in 46 of the total 200 cases, and only two had positive results; lead in one and nicotine in the other.