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University of Tennessee College of Veterinary
Medicine
Department of Large Animal Clinical Sciences
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ItsFoal SeasoninTENNESSEE !!!
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Equine Dystocia

• My Mare cant have the foal
• Case No. 11-66-78

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Signalment

• Name Anna
• Sp Equine
• Gender Female
• Age 5 y.o
• Breed Arabian

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Story

• Date Sat 2/28/04
• 900 am
• Local clients
• Mare dystocia on her way
• 1100 am
• Mare dystociaSTILL on her way

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Story

• 1200 pm
• Mare cant be brought to UTCVM
• Dr. Hanrath Dr. Coffer agreed to treat the mare
  in the field
• Dr. J. Castro volunteered to go and help them
  (Drs/Student/Client/Mare Foal)

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Story

• 200 pm
• We finally faced reality

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To be continued
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MarePhysical Exam

• Weight 800 Lbs
• T Not taken
• P 40
• R 12
• MM Pale Pink
• GS Positive

• Mare was down on presentation
• Unable to get up
• Head of a foal protruding from vulva

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Foal

• Foal dead
• Within the birth canal
• Presentation Anterior
• Position Dorsal
• Posture Bilateral flexed carpi

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Plan

• Sedation 200 mg xylazine IV
• Epidural 100 mg xylazine 1.5 cc Carbocaine
  7.5 Sterile Water
• Banamine
• Vaginal Exam decide protocol
• Protocol Assisted Vaginal Delivery
  (AVD)
• or
• Fetotomy

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This is True Equine Emergency Field Service
Medicine !!!
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This is True Equine Emergency Field Service
Medicine !!!
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Dystocia

• Fetotomy performed through both carpi
• Remove both metacarpi
• Foal was pulled after unlocking flexed elbow and
  shoulder
• Placenta was passed
• Slight Uterine Prolapse, replaced immediately and
  didnt re-prolapse

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Thenowner elected fluids

• Dr. Castro and his catheters

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Post Dystocia

• Antibiotics
• 15 L of Normosol
• 1 L of Hypertonic
• C.M.C into the uterus
• No Oxytocin given due uterus prolapse

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Post Dystocia

• Mare was assisted to get up
• Helped to walk to the barn
• Catheter was pulled
• At the barn
• Eating hay
• Looks bright

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Instructions

• Keep her in the barn and monitor for pain, colic,
  lying down, decreased appetite.
• Monitor for T twice a day Call if T gt
  101.5
• PPG 20 cc IM BID x 3

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Instructions

• Bute 1g PO BID x 3
• Monitor for uterus coming out of vulva. Call
  immediately.
• Have a vet check her uterus on 2/29 or 3/30

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Follow up

• We dont know because
• Owner doesn't answer phone calls
• Owner doesn't return phone calls
• He hasnt paid the billha,ha,ha
• That explains his words
• I am not worried about the money

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Article

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Dystocia in a referral hospital setting approach
and results

• Byron CR, Embertson RM, Bernard WV, Hance SR,
  Bramlage LR, Hopper
• Rood and Riddle Equine Hospital, Lexington,
  Kentucky
• Equine Vet J. 2003 Jan35(1)82-5.

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METHODS AND RESULTS

• In the years 1986-1999, 247 dystocias were
  admitted
• 91 resulted in survival and discharge of the
  mare
• 42 in delivery of a live foal
• 29 of foals survived to discharge.

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RESULTS

• Period from hospital arrival to delivery for
  foals alive at discharge (23.0 /- 14.1 mins)
• Period from hospital arrival to delivery for
  foals (24.8 /- 10.6 mins)
• There was not significant difference

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RESULTS

• 71.7 /- 343 mins from chorioallantoic rupture to
  delivery for foals alive at discharge
• 853 /- 37.4 mins from chorioallantoic rupture to
  delivery for foals
• It was significantly less for foals alive at
  discharge than for foals not surviving

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RESULTS

• Of mares bred in the year of the dystocia, 59
  had a live foal in the year following.

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CONCLUSIONS

• Dystocia duration has a significant effect on
  foal survival.
• Resolution methods should be chosen to minimize
  this time
• The difference between mean dystocia duration for
  foals that lived and those that did not in this
  study was 13.6 mins

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Equine Obstetric Emergencies

• Dystocia

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Dystocia

• It is a term that describes any type of foaling
  problem that prevents the foal from being
  delivered without assistance
• It is recognized as being one of the true
  emergencies in equine practice

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Dystocia

• Life threatening for both the mare and the fetus
• Requires immediate obstetric assistance

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Significance of Dystocia

• Mare
• Continued unproductive straining may cause damage
  to her reproductive tract. (Tears)
• Uterine damage can cause fatal peritonitis or
  hemorrhage

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Significance of Dystocia

• Mare
• Retained placenta
• Uterine prolapse
• Other
• Endotoxemia
• Metritis
• Laminitis

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Significance of Dystocia

• Foal
• Placenta detachment deprive the fetus of oxygen

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Nature

• Maternal
• Fetal
• Mechanical

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Maternal

• Uterine inertia
• Systemic disease
• Reduction of pelvic canal
• Pelvic fractures
• Sacroiliac luxation
• Tumors

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Fetal

• Improper positioned
• Malformation
• Oversized
• Twins

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Mechanical

• Fetopelvic disproportion
• Uterine Torsion
• Stenosis of the cervix vagina
• Congenital abnormalities (hydrocephalus)

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Stages of Parturition
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Clinical Signs

• Waxing (1-4 days before foaling)

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First Stage

• Last 1 4 hours
• Characteristics
• Uterine contraction
• Cervical relaxation
• Rotation of the fetus from
• Dorso pubic, flexed position to dorso sacral,
  extended position

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First Stage Clinical Signs

• Appear anxious
• Sweet
• Look and kick at her sides

If disturbed the progressive stagesof
parturition may stop.
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First Stage Clinical Signs

• May lie down intermittently

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First Stage Clinical Signs

• Rolling

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Second Stage

• It is completed in 10 30 min

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Second Stage Steps

• Rupture of the chorioallantois
• Release of allantoic fluid

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Second Stage Clinical Signs

• Protrusion of the amniotic sac through the vulva
  (whitish, bulging) several minutes after rupture
  of chorial allantois

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Second Stage Clinical Signs

• Forelegs appear extended

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Second Stage Clinical Signs

• Extended head between carpal joints

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Second Stage Steps

• The foal is expelled

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Third Stage

• Expulsion of the fetal membranes
• Occurs within thefirst 3 hours afterbirth

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Space Orientation

• Presentation
• Position
• Posture

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Presentation

• The direction the foal is facing relative to the
  long axis of the mare
• Anterior
• Posterior
• Transverse

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Anterior Presentation

• Anterior Longitudinal
• Normal
• The foals head is presented towards the mares
  vulva preceded by the feet

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Posterior Presentation

• Posterior Longitudinal
• Back to front
• The foals rump is presented towards the mares
  vulva preceded by the feet
• Breech

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Transverse Presentation

• Uterus is distorted to accommodate this rare
  presentation
• Foals lies at the right angles to the mares
  spine
• i.e It occupies both uterine horns

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Position

• Describes the relationship between the foals
  back and the mares spine
• Normal birth dorsal position
• Later pregnancy
• Lateral position
• Ventral position

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Posture

• The disposition of the extremities (neck and
  limbs), relative to the body
• Extended
• Flexed

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Normal Delivery

• Presentation Anterior
  Longitudinal
• Position Dorsal Sacral
• Posture Extended extremities (head, neck,
  forelimbs)

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History Presenting Signs

• Prolonged discomfort
• Sweating
• Straining without appearance of the amnion
• Appearance of the amnion or a limb or head
  without further progress

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Diagnosis

• Perform quick physical exam
• Take the history while the mares perineal region
  is washed with soap and the vulval lips dried

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Diagnosis

• Restrain the mare
• If necessary sedate the mare with Xylazine 0.2
  0.4 mg/Kg in combination with Butorphanol 0.05
  0.01 mg/Kg.
• After good lubrication of the arms of the
  operator, the position of the foal should be
  assessed and decisions made concerning attempted
  correction of the dystocia.

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Remember

• Be Clean
• Be Gentle
• Use a lots of lubrication

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Common CausesofDystocia
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Unilateral Carpal Flexion
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Bilateral Carpal Flexion
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Lateral Deviationof the Head
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Ventral Deviationof the Head
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Elbow Flexion
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Bilateral Hock Flexion
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Bilateral Hip Flexion(Breech)
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Anterior Presentation, Dorsal Position, Extended
Posture
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Dog Sitting Position
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Anterior Presentation,Ventral Position
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Posterior Presentation, Ventral Position,
Extended Posture
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Dorso Transverse Presentation
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Ventrotransverse Presentation, Uterine Body
Gestation
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Ventrotransverse Presentation with Ventral
Displacement of the Uterus, Bicornual Gestation
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Twins
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Procedures Used to Resolve Dystociain the Mare
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Protocol

• Restrain the mare
• Avoid stokes
• Holder standing at the head on the same site as
  the obstetrician
• Sedate the mare
• Xylazine 0.2 0.4 mg/Kg
• with
• Butorphanol 0.05 0.01 mg/Kg.

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Protocol

• Epidural (/-)
• Clip and prep caudal back of the patient
• Epidural Space C 1-2
• Dose
• 100 mg xylazine
• 1.5 cc Carbocaine
• 7.5 Sterile Water

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Protocol

• DELIVERY
• Oxitocin
• 20 UI/450 Kg mare IV,IM,SQ q2h
• Antibiotics
• Option
• K-Pen 22,000 IU/Kg/IV q 6h or
• PPG 22,000 IU/Kg/IM q 24h and
• Gentamicin 6.6 mg/Kg q 24h

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Protocol

• Antibiotics
• Option
• Ceftiofur 3.0 mg/Kg IV or IM q12 h and
• Metronidazole 15 mg/Kg PO q8 h
• Analgesics
• Flunixin 1.1 mg/Kg IM/IV q 12 h or
• Phenylbutazone 2.2 0.4 mg/Kg IV q 12h

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Protocol

• Flushing the uterus
• 2 4 L of saline
• Infusing the uterus
• 2.0 g Oxytetracycline in 100 200
• ml saline solution, if there is no
• response to oxytocin

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Considerations

• The viability of the fetus
• Economics of the case
• Clinical skills of the obstetrician
• Proximity to a referral hospital

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Procedures Used to Resolve Dystocia in the Mare

• The vast majority of dystocias can be corrected
  at the farm fairly quickly by brief manipulation
  and assisted vaginal delivery
• If resolution takes longer than 10 - 15 minutes
  consider one of the following options

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AssistedVaginal Delivery (AVD)

• Where the mare is awake and is assisted to a
  small or large degree in vaginal delivery of an
  intact foal

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Fetal Extractors
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Fetal Extractors

• Do not use fetal extractors in mares.
• Its use may produce severe, irreversible trauma
  to the dam and fetus.
• The traction force generated by the fetal
  extractor exceeds the maternal force by nearly
  six times.

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Fetal Extractors

• Forced Traction Force (in lbs.)
• Maternal 150
• Two strong men 250
• Fetal extractor 800
• Tractor 10,000

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Obstetric Chain Strap
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Correction of the Base of the Neck
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Correction of Hock Flexion
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Controlled Vaginal Delivery (CVD)

• Where the mare is anesthetized and the
  clinician is in completecontrol of delivering
  anintact foal vaginally

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Emergency Anesthesia

• Premedication
• Xylazine 0.3 0.6 mg/Kg IV and
• Butorphanol 0.01 0.02 mg/Kg IV
• Wait 3 5 min to peak effect
• Induction
• Ketamine 2.2 mg/Kg IV with
• Diazepam 0.05 0.10 mg/Kg IV

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Emergency Anesthesia

• Maintenance
• Triple Drip
• 1 L 5 Guaifenesin
• 1 2 g Ketamine
• 250 500 mg Xylazine
• Titrate
• 1 2 ml/Kg/Hour
• 1 2 drops/sec for a 450-Kg adult, using a
  standard 10 drops/ml administration set.

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Fetotomy

• Indicate if the fetus is dead
• Mare well restrained and sedated
• Epidural anesthesia
• Make transverse and oblique cuts

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Fetotomy

• Make cuts keeping the head of the fetotome in the
  hollow of the hand and maintaining finger contact
  with the fetus at all times
• Keep the number of incisions to the minimum
• Transect flexed extremities through the joints
• Avoid cutting long bones

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Fetotomy
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Amputation of the Base of the Neck
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Fetotomy Foreleg
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Fetotomy Throughthe Tarsus
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Bilateral Hip Flexion Amputation
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Cesarean Section
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Acknowledgment

• Teresa Jennings
  Instructional Resources/ Graphic
  Illustration UTCVM

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Questions ?
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References

• Orsini Divers Manual of Equine Emergencies
  Treatment and Procedures. Saunders 2002 478-482
• Rose Hodgson Manual of Equine Practice.
  2nd.Edition Saunders 2000 360

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References

• Hafez, E Reproduction in Animals. 7th Edition.
  Lippincontt Williams Wilkins. 2000 275-6.
• Sertich, Patricia Periparturient emergencies. The
  Veterinary Clinics in North America. Perinatology
  1994 19-36.

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References

• Embertson RM. Dystocia and caesarean sections
  the importance of duration and good judgment.
  Equine Vet J 1999 31179-180.
• Byron CR, Embertson RM, Bernard WV, et al.
  Dystocia in a referral hospital setting approach
  and results. Equine Vet J 2003 3582-85.

111
References

• England, Gary Allens Fertility and Obstetrics in
  the Horse. 2nd Edition. Blackwell Science.1996.
  155-156
• Frazer, G.S Recent Advances in Equine
  Reproduction International Veterinary Information
  Service (www.ivis.org), Ithaca, New York. 2001

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References

• Frazer GS, Perkins NR, Embertson RM. Correction
  of equine dystocia. Equine Vet Educ 2002 527-32
• Arthur, G. Veterinary Reproduction and
  Obstetrics. Saunders.1996 256 - 270

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References

• Blanchard Manual of Equine Reproduction. Mosby.
  1998 82-91
• Morel, D. Equine Reproductive, Physiology,
  Breeding and Stud Management. 2nd Edition. Cabi.
  2003 197 - 2002