Page 80 - June 2015

high risk pregnancy where the fetus is showing a lot of stress, is to try to relieve that stress and keep the uterus from contracting. There is a whole range of treatments that can be initiated, depending on the evaluation,” says Tibary.
“If there is an infectious process going on, such as if the mare has been in surgery or has placentitis, she will need to be on systemic antibiotics. She would also be on non-steroidal anti-inflammatory drugs,” he says.
“Another thing we have learned in recent years in managing the stressed fetus is to try to provide additional oxygen to that fetus. When there’s a problem, one thing leads to another and before you know it, the placenta is not car- rying enough oxygen to the fetus, and this will become fatal,” he explains.
There are several ways to improve oxygen- ation of the fetus. “Depending on the level
of the stress and how far the owner wants to
go with expenses, there are drugs like pent- oxyphiline, which helps to scavenge many
of the byproducts of inflammation and also promotes oxygen supply. Vitamin E is also used in large doses in treating some cases of placen- titis and a stressed fetus. Mares that are not doing very well should also be on a dextrose or glucose drip because this is the main nutrient for the fetus,” he says.
“Some mares have such poor perfusion that we also put the mare on oxygen to
Placentitis is an inflammation of the placenta usually caused by an infection and can be managed with certain treatments such as antibiotics and by providing additional oxygen and nutrients to the fetus, but can compromise the mare and foal. A decision may need to be made to deliver the foal a little early.
Prolonged pregnancies can be high risk to the foal and to the mare and can lead to placental separation, or red bag, among other problems.
improve her condition and help get more oxygen to the fetus. Many practitioners try to reduce the uterine contractions. This can be done by providing the mare with more progesterone. Regumate tends to relax the uterus. Some of these mares may be put on a double dose of Regumate during these episodes,” he explains.
“As pregnancy advances, the high risk pregnancy will eventually turn into a high risk foal. We try to manage the pregnancy, but we also have to be looking at the end result and whether or not the foal will be compromised. In the case of placentitis when the foal is stressed, it may survive even if it is delivered a little early. It’s not like a premature foal that is not ready to survive outside the uterus. With placentitis, the fetus has had more time to adjust and it can mature quickly at the end of the pregnancy,” he says.
At the other extreme is the abnormally long pregnancy. Some mares go a month or more overdue. “This can be high risk for the foal. We see quite a few prolonged pregnancies, particu- larly in the case of congenital hypothyroidism of the foal. In our region, this has been linked to mustard toxicosis (if mares have been eating mustard plants). Once in awhile, we have years where this happens more often. There’s also
the typical prolonged pregnancy due to fescue toxicosis. This problem also leads to placental edema, placental separation at birth (red bag), and lack of milk in the mare,” says Tibary.
“Sometimes, we try to define the high risk pregnancy, such as risk for embryo or fetal loss,
or a high risk for the mare herself. In the latter situation, the mare is already compromised in one way or another. The third definition is not as much a risk for the mare, but a problem for the foal. Some of these cases may also predis- pose the mare to problems, but not during the pregnancy. The risk would come during or right after foaling. The mares that have pro- longed pregnancy and placental edema may be at higher risk for early placental separation (red bag) or placental retention, for instance, which can be deadly in mares,” he explains.
With any of these situations, you want to closely monitor mares as they approach foal- ing and be present when they foal. “If a mare comes in with a uterine torsion or had a colic surgery and is in her 10th month of gestation, we might want to keep her in the hospital and monitor her closely to see when she might begin foaling. With mares that have had a problem and resolved it earlier, we don’t keep them in the hospital, but many owners will bring them back for a foal watch just to make sure everything goes okay.”
The owners have a financial and emotional investment in these mares, and after getting a problem mare this far, they want to make sure she has a successful delivery and a viable foal. They want to give that foal the best chance.
Some of these foals will be normal, and some will need help. “It all depends on how critical the mare’s condition was and whether the foal was severely compromised. If the situ- ation was extremely severe, most mares cannot carry the pregnancy; they will just abort. At
78 SPEEDHORSE, June 2015
A high-risk pregnancy can turn into a high-risk foal and, in some cases, a premature foal that may have a hard time surviving outside the uterus.
equine health
Ahmed Tibary DVM Ahmed Tibary DVM