Page 490 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Reproductive system: 2.1 The female reproductive tr act 465

VetBooks.ir If the haemorrhage continues and/or the mesome- 2.73
trium ruptures, unlimited extravasation of blood
into the peritoneal cavity will lead to haemorrhagic
shock. In severe cases, exsanguination and death can
occur within minutes to a few hours.

Clinical presentation
Mares are usually affected during or just after par-
turition, but occasionally late gestational or 24–48
hour post-parturient cases occur. Mild or restricted
bleeding cases tend to demonstrate mild to severe
abdominal pain (depending on the degree of haem-
orrhage) with signs including Flehmen response,
sweating and anxiety. Severe or unrestricted cases
have signs of blood loss shock, including pale mucous
membranes, thin, thready and rapid pulse, delayed
capillary refill time, collapse or inability to stand
after foaling or recumbency, shaking and sweating.

Diagnosis
Most cases can be identified given the clinical pre-
sentation and timing following foaling. In cases that
haemorrhage rapidly into the peritoneum, further Fig. 2.73 Transrectal ultrasonographic view of a
diagnostic tests, including rectal palpation, are often haematoma within the broad ligament 24 hours post
futile or dangerous because of the behaviour of the partum. (Photo courtesy Tracey Chenier)
mare. Mares that present with milder clinical signs,
especially abdominal pain, should be examined per Some clinicians recommend this for several weeks
rectum very carefully for the presence of a meso- post partum to help prevent haemorrhage recurring.
metrial haematoma, which can vary in size from an Anti-fibrinolytic drugs (tranexamic acid or amino-
egg to a melon. Palpable pain in the area in the early caproic acid) can be used to aid clot stabilisation,
stages is common. Ultrasonographic examination although their effectiveness is unknown. Fluid ther-
per rectum (Fig. 2.73) is also a possibility and will apy has been used in some cases with variable results,
confirm the condition. Transabdominal ultrasound but the stress of setting it up may well exacerbate the
and abdominocentesis will reveal free blood in the problem. Two to four litres of warmed hypertonic
abdominal cavity if the haematoma is torn, and saline (7%) or Hetastarch given quickly, followed by
raised protein levels if it is not. Assessment of the 10–20 litres of warmed polyionic crystalloid solu-
haematology parameters of the mare is of variable tion, will restore some circulatory volume. Other
use. In the peracute case the haematocrit often does clinicians have used whole fresh blood or plasma to
not change significantly and will often not change in improve blood pressure and help replace clotting
less severe cases for 12–24 hours. factors. Intravenous formalin solution (50 ml 10%
formalin in 1 litre of saline) has been used controver-
Management sially by some clinicians to decrease the haemorrhage.
There is no one reliable treatment and a combina- The use of sedatives in such cases is controversial, as
tion of therapies is often used. It is recommended to although most of these drugs lower blood pressure,
keep the mare quiet and minimise any stress in order which may help clotting and decrease blood loss, they
to keep the blood pressure low. The foal should can lead to severe cardiovascular collapse and death.
be kept in a safe place, but in view of the mare. Nasal insufflation of oxygen at 5–10 litres/minute