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Medical Problems in the Immediate Postpartum Period

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Medical Problems in the Immediate Postpartum Period HOW TO MANAGE THE SUBFERTILE MARE Medical Problems in the Immediate Postpartum Period Ahmed Tibary, DMV, PhD, Diplomate ACT*; Lisa K. Pearson, DVM, MS, Diplomate ACT Postpartum complications represent a large proportion of broodmare practice. The aim of the present article is to provide a concise review of the clinical assessment of the compromised mare in the immediate postpartum mare. Diagnostic approach and treatment of the most common genital causes of postpartum complications is provided. Authors’ address: Department of Veterinary Clin- ical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164; e-mail: [email protected]. *Corresponding and presenting author. © 2012 AAEP. 1. Introduction ation and therapeutic strategies may be required Postpartum complications in the mare may arise after evaluation of the mare, placenta, and foal. any time within the first 2 weeks after foaling. There are several factors that may increase the This time frame is arbitrarily chosen because most risk of postpartum problems in the mare. Some of mares are expected to be in heat and re-bred be- the historical relevant data may be from previous tween 10 to 20 days postpartum. Evaluation of the foalings, whereas other data pertain to the foaling parturient mare is often overlooked, particularly by on hand. small breeders or the single mare owner unless se- The age of the mare is relevant for very young vere complications are noticed. In stud farm con- mares with no previous foaling data as well as older ditions, resident veterinarians will have a standard mares (greater than 17 years) that may be prone to protocol for assessment of the postpartum mare. specific conditions such as uterine artery rupture. This article reviews the principles for evaluation of Some breeds (miniature, draft breeds) are predis- the postpartum mare and some of the most impor- posed to metabolic disorders. Mares with a previ- tant complications in the immediate postpartum ous history of dystocia or postpartum conditions are period. generally considered at an increased risk, but this has not been thoroughly evaluated. Other condi- Clinical Assessment of the Postparturient Mare tions that should be considered are history of re- Clients should be educated to call for veterinary tained placenta or previous injury to the examination of the postpartum mare within 12 to 18 reproductive tract (perineal or cervical laceration). hours of foaling, even when everything seems to be Risk factors relative to the foaling at hand include normal. Complete clinical examination of the mare high-risk pregnancy mares, colic surgery during ges- should be performed efficiently and without stress so tation, late-term pregnancy complications (placenti- that the mare-foal bonding is not disturbed. It is tis, uterine torsion, etc), abnormal (too short or too important to remember that further clinical evalu- long) pregnancy length, unsanitary foaling condi- NOTES 362 2012 ր Vol. 58 ր AAEP PROCEEDINGS Orig. Op. OPERATOR: Session PROOF: PE’s: AA’s: 4/Color Figure(s) ARTNO: 1st disk, 2nd beb spencers 11 3 3278 HOW TO MANAGE THE SUBFERTILE MARE tions, weak or dead foal, and unattended foaling. Transabdominal ultrasonography is the technique The preparation of the mare for foaling is an impor- of choice of evaluation of the postpartum sick mare tant factor in this evaluation. Preventive mea- and is very helpful in detection of abnormal perito- sures such as vaccinations and antiparasite neal fluid (ie, peritonitis, hemoperitoneum, uroperi- treatment, nutrition, monitoring during the last few toneum). Abdominocentesis and analysis of days of pregnancy (ie, mammary gland secretion), as peritoneal fluid should be part of the evaluation of well as any history of illness during pregnancy the postpartum mare whenever foaling has necessi- should be discussed with the owner. tated major obstetrical intervention (dystocia re- Evaluation of the mare that had an apparently solved by manipulation or fetotomy) or when the normal foaling and no apparent problems in the mare is severely depressed with signs of colic that is immediate postpartum period should start with ob- nonresponsive to initial therapy. Incoordination servation of maternal behavior and acceptance of (ataxia) or poor ambulation of the mare and/or lack the foal. Many postpartum conditions will often of urination warrants further examination for com- result in poor foal-mare bonding. Physical exami- pressive lesions within the spinal column or pelvis. nation should include assessment of the mucous Mares displaying depression or fever should be membranes, examination for abrasions around the monitored by repeated abdominocentesis. If a sin- eyes or tuber coxae, determination of heart rate, and gle parameter is changed (increased total protein evaluation of lung sounds and respiratory rate. [TP], white blood cell [WBC] count, or percentage of The digestive tract should be evaluated by listening neutrophils), continue monitoring. If two parame- to gut sounds in all quadrants and evaluation of ters are changed (TP Ͼ30 g/L, WBC count Ͼ15 fecal production. Observation of urination is an ϫ109/L, Ͼ80% neutrophils), immediate action is re- important parameter in the evaluation of the post- quired. These parameters are usually indicative of partum mare. Lack of urination may be due to peritonitis or severe gastrointestinal compromise ruptured bladder, painful conditions preventing the and require initiation of fluid, anti-inflammatory, mare from assuming normal urination posture, or and antibiotic therapy. Evacuation to a specialized retrograde urine spilling into the uterus. Inability referral center should be considered. to void urine normally may become complicated by Often the veterinarian is called because of a dysto- urinary bladder paralysis/atony. The mammary cia in progress or because the owner has noticed gland should be carefully examined to assess normal abnormalities in the placenta or the mare’s de- function. Ideally, colostral quality should be as- meanor. It is very important that mares with signs sessed immediately after foaling, using a Brix re- indicating a developing complication be confined to a fractometer. External evaluation of the perineal calm area and special attention be given to avoid region for swelling or discharge is important, partic- accidental injury to the foal by a colicky, depressed, ularly if the mare is a maiden or was unattended or uncoordinated mare. Use of sedatives should be during foaling. Vaginal examination is highly rec- carefully considered because of the depressive ef- ommended. The mare and foal should continue to fects they may have on an already compromised be monitored for a few days for normal behavior, mare. appetite, thirst, defecation, and urination. System- atic uterine lavage has been advocated by some vet- Specific Conditions of the Postpartum Period erinarians for all mares, but the authors are not in Complaints in the immediate postpartum period favor or such practice unless there is evidence of may vary from a simple behavioral problem (foal complications. The best measure to guarantee nor- rejection) to severe colic syndrome. Most of the mal postpartum involution is providing adequate complications observed are directly related to the physical exercise for the mare. gastrointestinal or urogenital system. Although Evaluation of the placenta is an integral part of retained placenta is one of the major complications/ the evaluation of the postpartum mare as well as the emergencies in the postpartum mare, it will not be health of the neonate. Clients should be educated discussed here because it is presented in another to examine or at least collect, weigh, and keep the paper in these proceedings. placenta in a cool area (cooler or refrigerator) until examined by the veterinarian. Overuse of oxytocin Septic Metritis in postpartum mares has been a major problem in Septic metritis accounts for 8% of postpartum emer- the authors’ experience, and for this reason we pre- gencies and may be seen in mares as a result of fer not to recommend its use until the mare is dystocia, partial or total retained placenta, and/or evaluated. excessive nonjudicious obstetrical manipulations.1 Advanced clinical evaluation and possibly hospi- The syndrome can be very acute or develop over 2 to talization is highly recommended in all cases with a 3 days postpartum. Clinical signs are variable and history of dystocia, retained placenta, or clinical include fever, depression, tachycardia, injected mu- signs of colic, hemorrhage, or toxic shock. Baseline cous membranes, a toxic line, and bounding digital complete blood count (CBC) and blood biochemistry pulses. Fetid vaginal discharge may be noted when panels should be obtained before initiation of ther- walking the mare or after palpation. Palpation per apy. Digital pulses should be evaluated frequently. rectum may reveal a thin-walled, distended uterus. AAEP PROCEEDINGS ր Vol. 58 ր 2012 363 Orig. Op. OPERATOR: Session PROOF: PE’s: AA’s: 4/Color Figure(s) ARTNO: 1st disk, 2nd beb spencers 11 3 3278 HOW TO MANAGE THE SUBFERTILE MARE Vaginal examination may reveal other cervical and are generally grouped under the term of “pregnancy vaginal lesions in addition to a foul-smelling dis- sclerosis.”1,7 Other predisposing factors cited in charge. Ultrasonography often shows a large vol- the literature include previous episodes of hemor- ume of intrauterine fluid with high cellularity. rhage. The right side appears to be more prone to Placental tags
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