Reproductive emergencies in the mare (Proceedings) - Veterinary Healthcare
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Reproductive emergencies in the mare (Proceedings)


CVC IN SAN DIEGO PROCEEDINGS


Occurrence

• Breeding
     o Rectal tears
          • Palpation
          • Penetration by stallion
     o Vaginal Tears
          • Penetration by stallion
• Peri-parturient
     o Dystocia
     o Hemorrhage
     o Uterine
          • Torsion
          • Prolapse
          • Rupture / tear
          • Retained fetal membranes
          • Metritis
     o Vagina
          • Rectovaginal Tears
     o Gastro-intestinal
          • Damage to viscera
          • Rectal prolapse

Breeding associated emergencies

• Rectal Tears
     o Associated with:
          • Palpation
          • Penile penetration of rectum by stallion
     o Signs
          • "Feeling" of release of rectal tissue around arm
          • Blood on sleeve or penis
          • Onset of shock
          • Signs of peritonitis
          • Usually colic
          • Straining to defecate
     o Types
          • Grade 1
               - Involves only rectal mucosa and submucosa
          • Grade 2
               - Through muscular layer
          • Mucosa and submucosa intact
               - No bleeding
               - Forms diverticulum
          • Grade 3a
               - Only serosal layer is intact
          • Grade 3b
               - Occurs dorsally
               - Mesorectum and retroperitoneal tissues are intact
          • Grade 4
               - All layers disrupted
               - Fecal contamination of peritoneum
     o Incidence
          • Most occur dorsally
          • 15 – 55 cm from the anus
          • In one retrospective study of 85 horses with rectal tears (Eastman TG et al Equine Vet Edu 2000 12(5):263-266.)
               - 47/85 associated with routine pregnancy exams
               - Grade 1 - 93% survived to discharge
               - Grade 2 – 66% (2/3) survived to discharge
               - Grade 3a – 70%
               - Grade 3b – 69%
               - Grade 4 – 6%
          • Few cases of penile penetration in literature
               - 2 at MDS-EMC in last 5 years
               - Both lateral wall
               - Grade 3b
               - Both survived
     o First-Aid for Rectal Tears
          • Exam of tear
          • Sedation
          • Buscopan
          • Careful palpation
          • Remove feces
          • Pack rectum
               - 20 cm cranial to tear
          • Close anus
          • Epidural
               - Transportation concerns
          • Antibiotics
               - Broad spectrum
               - Penicillin (potassium or sodium penicillin 22,000 IU; IV)
               - Gentamicin – 6.6 mg/kg IV
               - Metronidazole – 15 mg/kg PO
          • Flunixin meglumine – 1.1 mg/kg IV
          • Tube with oil
          • IV fluids
               - If in shock
          • Withhold food
          • Refer for evaluation
• Vaginal Tears
     o Occur during intromission
     o Uncommon
     o Mild to severe trauma to vagina
     o Vaginal rupture
          • Usually adjacent to cervix
          • Dorsolateral
          • Can also affect lateral wall of vestibule
          • Semen is not sterile
          • Results in peritonitis
          • Evisceration (Tulleners EP et al JAVMA 1985 186(4): 385-7)
     o Partial thickness
           • Peri-vaginal abscessation if not identified acutely
     o Signs
           • Vaginal bleeding
           • Colic
               - Minutes to hours post-breeding
           • Straining
           • Peritonitis (signs)
           • Fever
            • Depression
           • Lethargy
     o First Aid for Vaginal Rupture
           • Broad spectrum antibiotics
            • Peritonitis
           • Flunixin meglumine
           • If evisceration:
               - Reduce and pack with sterile soaked towels
               - Large enough so they won't pass into the abdomen through the tear
               - Close vulva
               - Clamps or suture closed
           • Treat shock
           • Refer for medical and surgical treatment


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Source: CVC IN SAN DIEGO PROCEEDINGS,
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