Page 491 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

466 CHAPTER 2

VetBooks.ir has also been used to increase tissue oxygenation. secondary to other conditions such as hydrops, uter-
ine torsion, obstetric manipulations during a dysto-
Corticosteroids have been used and, after the initial
crisis, broad-spectrum antibiotics, antioxidant drugs
of the hindlimbs. Tears not associated with dysto-
and anti-inflammatory medications such as flunixin cia or, rarely, excessive fetal movement, especially
meglumine should be administered to control pain cia tend to occur towards the tip of the gravid horn.
and prevent abscess formation in the haematoma. Late-pregnancy ruptures may lead to part, or all,
Foal nutrition should be supported during this time. of the fetus assuming an intraperitoneal position.
The majority of tears occur on the ventral aspect of
Prognosis the uterus and they can be partial or full thickness.
In general, where the bleeding is restricted to the The latter can lead to peritonitis and death. A tear
mesometrium and a broad ligament haematoma of the uterus may involve a large blood vessel and,
forms, the mare will survive. The haematoma organ- occasionally, visceral herniation may complicate the
ises and fibroses with time and can often be palpated condition.
rectally for many years afterwards. The mare can
be bred as soon as the haematoma is fully fibrosed, Clinical presentation
which can be ascertained by ultrasound examination Partial-thickness lacerations are often not detected
per rectum. As a minimum this will usually have unless the uterus is examined in detail post partum.
occurred by the second oestrus post partum, but Uterine rupture is not usually associated with
resting these mares until the following year may be severe haemorrhage into the abdomen, but if this
necessary depending on the clinical examination. It does occur, the mare may present with haemor-
is unknown whether these mares have an increased rhagic shock and rapid death. If the rupture occurs
tendency to further haemorrhages in subsequent in late pregnancy and the foal becomes partially or
pregnancies. Intra-abdominal haemorrhage usually entirely intraperitoneal, the mare may develop late-
leads to death. pregnancy abdominal pain and possibly intestinal
complications related to adhesions and peritonitis.
UTERINE RUPTURE Full-thickness ruptures post partum can heal spon-
taneously and may not be detected, whereas other
Definition/overview cases develop peritonitis due to contamination from
Uterine rupture is an uncommon condition, usu- the uterus. These present with abdominal pain and
ally secondary to other problems occurring at par- guarding, fever, depression and signs of endotoxae-
turition. Uterine lacerations are most frequently mia and septic shock. Occasionally, ruptures (partial
detected following a dystocia but can occur in mares or full thickness) are not recognised until uterine
following a normal foaling. Tears may be partial or lavage is carried out post partum; fluid pumped into
full thickness and are often ventral. Partial tears the uterus is not retrieved because it flows into the
are often not detected and may heal spontaneously abdominal cavity.
with uterine involution. Full-thickness tears can be
associated with abdominal pain, severe peritoneal Diagnosis
haemorrhage and/or contamination, or even a pre- Identifying a uterine rupture (partial or full thick-
parturient peritoneal fetus. Death can occur due to ness) can be challenging. Examination of the uterus
severe peritonitis and/or intestinal complications. manually per vagina, rectal palpation and transrectal
Surgical repair via a ventral midline laparotomy and ultrasonography post partum can confirm the pres-
intra- and postoperative peritoneal lavage are essen- ence of a uterine injury but the inability to identify
tial in treating full-thickness tears. one should not be taken as a fact that one is not
present. Palpation should be carried out carefully
Aetiology/pathophysiology in order to minimise extension of the laceration. All
Spontaneous rupture uncommonly occurs dur- mares that have had a dystocia should be checked
ing normal parturition, but more usually it occurs post partum for lacerations. Transabdominal