Equine Med- The Periparturient Mare

wilsbach's version from 2016-04-04 03:50

momma neigh

Question Answer
which hormone will tell you the mare has a VIABLE pregnancy?Estrone sulphate is secreted by the feto-placental unit and is the best way to dx a viable preg (eCG will be secreted by endometrial cups even if foal is dead so isn't as good)
what does eCG do?sustains the primary CL (makes it last longer). also takes follicular structures on ovary causes them to luteinize --> secondary CLs to secrete CLs and maintain preg.
diagram of the preg hormones
how long is gestationabout 330 d
less than how many days is considered premature and non-viable?<320
greater than how many days is considered post mature/prolonged gestation ?>370d
if a foal is post mature/ has been cooking for >370d how might it look when it comes out?usually normal but just small (hence prolonged I suppose)
If normal gestation is 330d and the foal is in there for like 370 days, what should you do? not do?DO NOT INDUCE. It'll come out, just be on the small side. Induction can lead to probs with dysmaturity
what is dysmaturity?Normal gestation, but signs of prematurity
what is a gross sign of pre/dysmaturity you can see right away?floppy ears
why do you wanna isolate pregnant mare from new introductions or young stock?worried about EHV-1 (abortion, respiratory disease and occasionally neonatal mortality)
around what point in gestation do you wanna move mom to the foaling area?300 days (so a mo before expected parturition)
never give what vx in preg?MLV
what vx do you wanna give extra on top of the cores for a preg mare, and at what time intervals? EHV-1 (inactive) @ 5, 7 & 9 months
when/with what do you wanna deworm preg mom?wanna do it regularly, ESP at parturition because of Strongyloides westeri (causes parasitic diarrhea in foals) use Ivermectin
what do you want mom's BCS to be?6 or 7/9 ( Want her in a positive energy balance for rebreeding (TB mares) )
what two dietary deficiencies should you DEF avoid in mom because they are super bad for baby? (what happens if she is deficient in these?)(1) Diets low in Iodine- can lead to congenital hypothyroidism (goiter) (esp a prob in western canada and the pacific northwest) (2) diets low in vit E/selenium--> cause WMD in foals
what toxic plant causes Congenital Hypothyroid Dysmaturity Syndrome in foals?mustard species
what problem does mustard species cause if mom eats it? what are the hallmarks of this problem?causes congenital hypothyroid dysmaturity syndrome in foals. This is characterized by an abnormally long gestation, Facial & lower jaw deformities, Limb deformities, hypothyroidism
what does fescue do if mom eats it? (pathogenesis)fescue is Infected with the fungus neotyphodium coenophilaum. Produces ergot alkaloids, which are dopamine agonists. Too much dopamine will suppress prolactin, and that leads to agalactica. High levels of dopamine also disrupt progestagens and relaxin
clinical signs of fescue tox?(remember that the fungi on it produces ergot alkaloids which work as DOPAMINE AGONISTS) see agalactica, prolonged gestation, thickened placenta (red bag deliveries), abortion. stillborn/weak foals
how do you tx fescue tox?Since the prob is fescue has N. coenophilaum--> ergot alkaloids--> dopamine agonists--> too much dopamine, you use a dopamine ANTAGONIST, ie DOMPERIDONE
3 things which are never normal in a preg mare(1) “Bagging up” before delivery (2) Vaginal discharge (hemorrhagic= varicose veins. purulent= placentitis) (3) drastic changes in body contours (ruptured prepubic tendon)
purulent vaginal discharge during preg might indicate?placentitis
*bagging up before preg is a sign of what?Cardinal sign of ascending placentitis. You might see milk dripping from the udder.
what sign tells you there is probably an ascending placentitis, and what is the main causative agent of this?you will see bagging up with ascending placentitis, and most common offenders are Strep. equi subsp. zooepidemicus or E. coli
how do you dx ascending placentitis?(see bagging up ofc but definitively is) Ultrasound – combined thickness of uterus & placenta (CTUP)
what is going on in this pic? This is a pic of how you measure CTUP (combined thickness of uterus & placenta) which can tell you if there is ascending placentitis or not
if you wanna monitor a high risk preg to make sure foal is fine, you can use US to look at what 3 things?(1) Fetus: HR and activity. (2) fluids: Amount & character of amniotic/allantoic fluids (will have floccules in it bc of waste products in it from fetus ). (3) Placenta: look at CTUP (combined thickenss of the uterus an placenta)
monitoring wellbeing of foal in utero--> what should you know about doing a vaginal exam for this? what are you looking for? NB! Asceptically!! can look for appearance of cervix, discharge
can drugs can you use to try to maintain pregnancy?Progesterone (Altrenogest “Regumate”)
two grossly visible signs of impending parturition?(1) Udder development: "waxing" (2) Muscle relaxation (due to Relaxin & Estrogen) Around tail head & gluteal muscles
what hormonal changes might tell you there is impending parturition?PROGESTERONE levels will drop sharply 24-48hrs before birth. monitoring P4 can predict abortion in sick mares
how will the milk electrolytes/pH change as partus approaches?Na goes DOWN, K and Ca go UP. (want milk to be sweeter for baby, not salty ;) ) then, the pH drops (foals like it sweet and sour LOL)
when is induction performed? (drugs?)RARELY PERFORMED!!! really bad for baby. Basically only performed to save mare, such as if there is a prepubic tendon rupture or herniation. This has to be done at a referral center with LOTS of planning. <10% chance of survival for the foal. [Drugs: Dexamethasone & oxytocin ]
never forget to do what before foaling?open the caslicks suture. lol..
what are the 3 stages of foaling?(1) Stage one: preparatory- cervical dilation. (2) Stage two: expulsion of fetus. (3) Stage 3: expulsion of fetal membranes
Don't forget fetal disposition shitPresentation (cr or ca or xverse), position (dorso-sacral, dorso-pubic, dorsal iliac L or R), posture (flexion or extension of limbs)
rule of 1,2,3?Standing in one hour, nursing in 2, expulsion of fetal membranes in 3
Any pieces of placenta remaining in utero might signal to worry about?Predisposed mare to metritis, laminitis, etc…
what are things you can see on placenta which might indicate there was placentitis? (how to tell hematogenous from ascending)Ascending @ cervical star. Hamatogenous @ umbilical attachment
stress in utero might be indicated if you see what?meconium staining
what might avillous areas indicate?Twins, endometrial cysts or fibrosis
If parts of placenta are gonna tear off, where is most likely place?in the preg horn
where is the placenta supposed to rupture?cervical star
what does this mean? if the cervical star hasn't ruptured, it means there was premature separation of the allantochorion
what does this mean? a large avillous area such as this indicates there was a twin
what does this mean? these are endometrial cups
when to intervene: how long of no progress after rupture of the allantochorion should you intervene?15min (short time!)
4 instances where you should intervene?(1) No progress within 15 mins after rupture of allantochorion (2) red bag delivery (ER!!) (3) Malposture (4) Rectovaginal delivery
why is red bad an ER?Placenta separating from endometrium (premature separation of the allantochorion) which means NO BLOOD SUPPLY TO FETUS
red bag delivery often seen with what problem?fescue tox
4 causes of red bag delivery?Fescue tox, placentitis, induced parturition, stress
if the mare's vag is all mangled and necrotic and infected after delivery, what kinda drugs do you wanna give?Nsaids (flunixin!!) and Abx
RFM after how long is swiftly becoming an ER?>3hrs
3 situations where there is higher incidence of RFM?Drage horses, Fescue tox, and old, multiparous mares
what are some complications of RFM?Strep zooepidemicus & E. coli infections, Bacteria & endotoxin absorbed leading to septicaemia and endotoxaemia, Uterine involution delayed, Metritis/endometritis, laminitis (lol ofc), uterine prolaps
tx of RFM? (general things to do AND drugs)Tie up RFM to prevent mare from stepping on it/kicking out. Oxytocin every 2-4 h Bolus or constant I/V infusion, broad spectrum abx, nsaids (flunixin), sole support, IV fluids, tetanus prophylaxis
how can you help prevent adhesions from cervical lacerations?AB/NSAID ointment (eg. panalog®)
when do you give final dx of a cervical laceration?Final diagnosis by digital palpation when mare is in luteal phase (part of BSE workup)
is uterine prolapse a big deal? what probs are associated with it?LIFE THREATENING!!!! (but uncommon) Mare will often develop signs of shock due to ischaemia & necrosis with endotoxaemia. Rupture of ovarian arteries & rapid death may occur
how do you treat uterine prolapse? (what drugs do you use for sedation? what drugs for epidural? what do you do? what meds do you give after?)Sedate with α2-agonists (eg. Detomidine). Epidural with lignocaine & xylazine for pain relief. Elevate prolapsed uterus, check for lacerations, clean and replace gently. Medications to give afterwards include oxytocin (helps with involution), systemic abx, and NSAIDs
common sequelae to uterine prolapse?metritis, laminitis, death
if you fix the owners horses uterine prolapse, tell them there is a poor prog like you should, but then they ask "well if she survives what are the chances it will happen again?" what do you say?not a high chance of recurrance in subsequent pregs
colicky post-partum mare: what are the two major body systems this colic can be coming from, and what are examples of what could be going wrong in each of these systems?(1) REPRO TRACT: traumatic injury, metritis, hge (broad lig), uterine tears or rupture. (2) GIT: cecal rupture, rectal prolapse, Trauma to small colon/small intestine, large colon volvulus (common- usually a few weeks post partum)
what is normal peritoneal fluid? what are normal changes after partus? what are DEF ABNORMAL?Normal= Clear, straw-colored fluid with a TP of <2.5g/dL and <5000WBCs. Post partum you might see elevations in like one parameter, and might be a bit cloudy but there should be no gross color change. ABNORMAL would be TP >3, WBC >15,000
how might you differentiate a bloody peritoneal fluid sample from a skin bleed you accidentally collected?peritoneal fluid should have a lower than normal PCV
how might you be able to tell if the peritoneal fluid you collected is from an ischemic bowel?Abdominal fluid PCV < Peripheral PCV, you will see high WBC, toxic neuts, and the horse will be SYSTEMICALLY ILL
how might you know if the peritoneal fluid is from a hemoabd?Abdominal fluid PCV= Peripheral PCV
how would you know if you have a splenic aspirate instead of a peritoneal fluid sample? Abdominal fluid PCV > Peripheral PCV
uterine tears are usually associated with?manipulation during partus(
if there is a small uterine tear what can you do?conservative tx with abx/NSAIDs
what is a "burns technique" and what is it used for?This is used for Partial invagination of a uterine horn-- fill uterus with water to make it pop back out into place
CSs of Partial invagination of a uterine horn?colic, discomfort
how can you try to tx Partial invagination of a uterine horn?(1) Try & restore to normal position with blunt extension (soda bottle) (2) burns technique= fill with water. Then maintain on low dose of oxytocin, give epidural/pain relief
what is the most common cause of death in the post-parturient mare?Hge into broad lig
huge into broad lig happens when what arteries rupture?one of the three branches of the uterine arteries
which side is more predisposed to hge into broad lig?R side (they don't know why)
rupture of the uterine arteries can bleed into what 3 places?(1) uterus (2) broad lig (most common) (3) peritoneal cavity
CSs of internal hge?Severe signs of colic/pain that cannot be controlled with the usual medication. Anxious, profuse sweating. Signs of hemorrhagic shockpale mucous membranes, low PCV, increased HR and RR, cold extremities
if there is hge into the broad lig what/where will you feel on palpation?Presence of a large mass dorsolateral of uterus (palpation and ultrasound) (Sometimes incidental finding at foalheat)
tx of hge into broad lig?MOST IMPORTANT: Keep mare quiet, avoid stress, keep blood pressure low, risk for rupture of broad ligament . Sedate. Do not separate from foal unless in danger (you will stres her more). Control pain (NSAIDs, butorphenol), Restore circulatory volume (fluids, hypertonic saline, Blood transfusion if clinical parameters are indicative. Do not wait for blood results.).
what drugs can you give to promote hemostasis for hge into broad lig? (4)(1) Aminocapric acid ( Inhibits proteolytic enzymes like plasmin, the enzyme responsible for fibrinolysis.) (2) Yunnan baiyao (3) Naloxone?? (4) Formalin?? (last two are in worst case scenario)
prog of hge into broad lig?If diagnoses and treated: 84% survival. 49% went on to have an additional foal