Therio - Dystocia & Puerperal Disorders

drraythe's version from 2017-09-10 04:03

Intro/ Dystocia/ Disposition

Question Answer
When are the 4 major times you are going to want to intervene in parturition?(1) No progress w/in 15 min after rupture of allantochorion
(2) Red bag delivery – EMERGENCY!
(3) Malposture
(4) Rectovaginal delivery
You are called to a foaling in a valuable Quarter horse mare. The owner reports that the mare started showing strong contractions about 30 minutes ago. You find the following: What is your Dx? Premature separation of the allantochorion (aka red bag delivery)
When do you expect to see vaginal prolapse?NOT COMMON IN HORSES, prolly not gonna see
When do you expect to see uterine prolapse?POST-foaling
Why does a red bag delivery happen?Bc placenta did not rupture at the cervical star
WHY is a red bag delivery an emergency?Blood supply to fetus lost bc Placenta separating from endometrium
Four main czs of premature placental separation?(1) Fescue Toxicity
(2) Placentitis
(3) Induced parturition
(4) Stress
How do you Tx premature placental separation?Open allantochorion ASAP, Extract fetus & resuscitate
What is wrong in this picture? Amnion still wrapped around fetus – will suffocate
How quickly does placental separation usually happen (& what are the implications of this for dystocia?)Placental separation happens w/in an hour, so if there is dystocia it is URGENT that it is corrected
Dystocia has a higher occurrence in what breeds?Draft horses 10%, Shetland ponies
Is there an age/ breeding disposition for dystocia?Young, Primiparous mares
What is 1 way to help w/ dystocia before the vet arrives?Slowly walking w/ the mare until the veterinarian arrives: will help slow down straining
Disposition → Presentation refers to what? What is normal?Long axis of fetus in relationship to mare. Can be Cr or Ca or transverse, Cr is normal
Disposition → position refers to what? What is normal?Dorsum of fetus in relation to pelvis of mare. Can be:
Dorso-sacral (normal)
Dorso-iliac (foal lying on its side – fetal dorsum to maternal ilium, or Dorso-ventral-- foal on back)
Disposition → posture refers to what? What is normal?Describes the fetal extremities (ie neck & limbs), normal is EXTENDED
Is malposture more or less common in horses & why?More common, bc long limbs & necks
What does normal disposition look like?Cranial presentation
Dorso-sacral position
Extended posture
What is this disposition? Cranial presentation, dorsosacral position, unilateral carpal flexion
How to Resolution of carpal flexion?
Describe the disposition of the foal Cranial presentation, dorsosacral position, unilateral shoulder flexion
What is Johne’s position? How do you fix it?The shoulders are in a downward/flexed position thereby increasing the total diameter of the chest. Repel the foal into the uterus by applying pressure to the chest & at the same time pull the legs in a full shoulder extension.
What is the disposition of this foal? Anterior (cranial), dorso sacral, Head deviated below front feet
What don't we like about this position where the head is deviated below the front feet?DANGER: Can cz a recto-vaginal tear
What is the disposition of this foal? Anterior (cranial), Dorsosacral, Ventroflexion of head & neck
What is the disposition of this foal? Anterior (cranial), dorsosacral, head flexion (Also known as “Wryneck” VERY difficult to correct bc of long neck. May require fetotomy)
What is wryneck, why don't we like this?Cr dorsosacral w/ neck flexion, super hard to correct bc neck so long-
How do you correct wry neck?
What is the big problem w/ posterior presentation?Get them out quick bc umbilicus is stuck on pelvic brim → cut off blood supply → asphyxiate foal
How to fix tarsal flexion in posteriorly presented foal?
What is the dog-sitter position? How do you fix this?Bilateral hip flexion.... Generally requires C-section to resolve
How would you fix this type of position? (What is this position?) Dorsal transverse... C-section in a living foal, or fetotomy
How would you fix this type of position? (What is this position?) Extraction in posterior presentation, or fetotomy

Obstetric exam

Question Answer
How should mare be positioned for the Ob exam?Mare should be standing for the initial exam (more space, less straining)
For an ob exam you can give Spasmolytic drugs...2 of these are?(1) Clenbuterol (czs smooth mm relaxation)
(2) Butylscopolamine bromide
The downside to using epidurals?Tends to stress mares if they can’t feel their hindquarters
How can you position the mare to make the ob exam easier?Elevate mare’s hindquarters – let gravity help you
How might you be able to differ a front from a back leg of the foal coming out?In front leg, Fetlock & carpus bend the same way. In back leg, Fetlock & tarsus bend the opposite way
If Soles of hooves pointing downwards...what are the possible conformations?Most likely anterior presentation, dorsosacral position. However, could be posterior presentation, dorsopubic position :(
Soles of hooves pointing skywards...what are the possible conformation?Anterior presentation (common)
Dorsopubic position (unusual)
Posterior presentation
Dorsosacral position
Some ways for you to try to determine if the foal inside the mom is dead or alive?Suckling reflex
Corneal reflex
Withdrawal reflex
Anal reflex
Umbilical pulse
How do you place foaling ropes?Above & below fetlock
Always have control of the head...what 2 devices to help w/ this?“War bridle” or head snare
TIME is of the essence... your chance of recovering a live foal dec by how much in what time?Every 10 min the chances of recovering a live foal decrease by 10% (approx.)
How can you position the mare during a controlled/assisted vaginal delivery to help make it easier?Let gravity help you – foal falls forward.
Things you need to fetotomy?

Post-partum exam of mare

Question Answer
3 things you should def check forCheck for uterine/vaginal tears
Check for bruising/bleeding
Check for twins!!!!
What kinda pain/antiinflammatory drugs would you like to give the mare?NSAID -Flunixin (prolly want ABx if theyre torn or anything too)
Most common complication?Retained fetal membranes
**How long until it would be considered RFM?> 3 h post foaling...SWIFTLY BECOMING AN EMERGENCY SITUATION
What czs RFM?Exact cz unknown... High incidence in draft mares, Fescue toxicity cases, old, multiparous mares
What are some complications that can arise from RFM?Strep zooepidemicus & E. coli Infxns → Bacteria & endotoxin absorbed leading to septicemia & endotoxemia. Uterine involution delayed, Metritis/Endometritis, LAMINITIS, Uterine prolapse
If you wish to manually remove some of the RFM, what DO you do & what DON'T you do?1st off, Tie up RFM to prevent mare from stepping on it/kicking out. Then you DO NOT PULL OR FORCE THE RFM. You can however, gently twist & apply pressure
What drugs do you wanna give in the case of RFM & why? (4)(1) Oxytocin every 2-4 h (help w/ contractions to get it out)
(2) Broad spectrum AB’s (prevent RFM from getting infected & causing more problems)
(3) NSAIDs eg. Flunixin
Perineal lacerations & fistulas-- grades are?(1) 1st degree: involves primarily mucosa & skin of the vulva
(2) 2nd degree: extends through musculature of the vulvar sphincter & compromises closure
(3) 3rd degree: complete disruption of the roof of the vestibulum/vagina, floor of the rectum & anus
(4) Recto-vaginal fistula: all layers btwn vagina & rectum are disrupted but anus remains intact
What’s a Grade 1 (1st degree) Perineal laceration/fistula?Involves primarily mucosa & skin of the vulva
What’s a Grade 2 (2nd degree) Perineal laceration/fistula?Extends through musculature of the vulvar sphincter & compromises closure
What’s a Grade 3 (3rd degree) Perineal laceration/fistula?Complete disruption of the roof of the vestibulum/vagina, floor of the rectum & anus
What’s a Recto-vaginal fistula?All layers btwn vagina & rectum are disrupted but anus remains intact
How much of an ER is a 3rd degree perineal laceration? How do you Tx?(Complete disruption of the roof of the vestibulum/vagina, floor of the rectum & anus) NOT life threatening! Treat conservatively in the acute stage... allow to heal by 2nd intention, then surgically correct
Diff btwn 3rd degree perineal laceration & a recto-vag fistula?In the 3rd degree, the anus is disrupted. In the fistula, the anus is intact
How to sx repair 3rd degree perineal laceration/fistula?
How should you repair Recto vaginal fistula?Wait until has healed by 2nd intention before attempting repair (Various surgical techniques described)
How to Dx cervical laceration?Diagnosed w/ speculum & palpation → Final Dx by digital palpation when mare is in luteal phase
How can you prevent adhesions w/ a cervical laceration?Prevent adhesions by applying AB/NSAID ointment (eg. panalog®)
What are CSs of a Partial invagination of a uterine horn?CSs post -partum like colic, & discomfort
How do you Tx & manage a Partial invagination of a uterine horn?(1) Try & restore to normal position w/ blunt extension (soda bottle)
(2) Maintain on low dose of Oxytocin
(3) Epidural/pain relief
How much of a ER is a uterine prolapse?LIFE THREATENING! (Luckily uncommon)
Why is uterine prolapse so super bad?Mare will often develop signs of shock due to ischemia & necrosis w/ endotoxemia. Can have Rupture of ovarian arteries & rapid death may occur
How do you sedate a mare for Tx of a uterine prolapse?Sedate w/ α2-agonists (eg. Detomidine). (AVOID tranquillizers!)
What can you give as an epidural for pain relief for the mare w/ a uterine prolapse?Epidural w/ Lignocaine & Xylazine for pain relief
How do you treat a mare for uterine prolapse?(1) Sedate w/ α2-agonists (eg. Detomidine) [AVOID TRANQS]
(2) Epidural w/ Lignocaine & Xylazine for pain relief
(3) Elevate prolapsed uterus, check for lacerations, clean & replace gently
The 3 medications you wanna give the mare after fixing a uterine prolapse?Low dose Oxytocin
Systemic AB’s
3 common sequelae to uterine prolapse?Metritis
Does having a uterine prolapse predispose to having another?No recurrence in subsequent pregnancies
What is the major concern when there is a uterine tear?Connection w/ abdomen? – Peritonitis!
How do you Tx a uterine tear?(Check w/ abdominocentesis) Conservative Tx (Ab/NSAID), maybe sx
What vessel(s) damaged to cz HGE into the broad ligamentRupture of 1 of the 3 branches of the uterine arteries
Is there is side preference for HGE into the broad ligament?More often on right side?!
Is there a relation to age w/ HGE into the broad ligament?Age-related – aneurisms, degenerative changes in the vascular walls
WHERE is the HGE when there is HGE into the broad ligament?Usually (almost always) bleeding w/in the 2 sheaths that compose the broad ligament
Symptoms of internal HGE of broad ligament? (4)(1) Severe signs of colic/pain that cannot be controlled w/ the usual medication
(2) Profuse sweating
(3) Signs of hemorrhagic shock: pale mucous membranes, low PCV, increased HR & RR, cold extremities
(4) Presence of a large mass dorsolateral of uterus (palpation & ultrasound) [*Sometimes incidental finding at foal heat]
Tx of HGE into the broad ligament?Keep mare quiet, avoid stress, keep blood pressure low, risk for rupture of broad ligament. Control pain (NSAID, Butorphanol, …). Blood transfusion if clinical parameters are indicative. Do not wait for blood results. Aminocaproic acid (inhibits clot lysis)
What can you give to inhibit clot lysis in the case of a mare w/ HGE into the broad lig?Aminocaproic acid
What is Aminocaproic acid? Why do we like this/ when do you use this?Use for HGE into broad lig. Prevents clot lysis. Aminocaproic acid is an effective inhibitor for enzymes such as proteolytic enzymes like plasmin, the enzyme responsible for fibrinolysis. Effective in Tx of bleeding disorders