Page 493 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

468 CHAPTER 2

VetBooks.ir 2.75 metronidazole) and NSAIDs (flunixin meglumine)
are preferably given prior to attempts to replace the
uterus in order to help prevent metritis and counter-
act endotoxaemia. The uterus should be placed on a
clean plastic sheet or tray and elevated, preferably to
the level of the vulva. This improves the uterine cir-
culation, thereby decreasing oedema, and decreases
the likelihood of blood vessel rupture and damage
to the endometrium. The uterus should be thor-
oughly cleaned with warm isotonic saline to remove
all debris and identify any damage. Lubrication
with obstetric lubricant may assist replacement and
decrease desiccation. If the placenta can be easily
detached without further damage to the uterus, this
should be undertaken prior to replacement. Areas
Fig. 2.75 A uterine prolapse post partum in a mare of damage may require protection during replace-
that was subsequently euthanased. (Photo courtesy ment and lacerations can be repaired with absorb-
Tracey Chenier) able sutures. Generally, the uterus is replaced under
sedation and epidural anaesthesia, with the hind-
quarters elevated on a slope or bank, but in some
damage and friability, and the placenta may still be cases, general anaesthesia and elevation of the mare’s
attached. There may be rapid development of shock hindquarters will be necessary. The prolapse is
and endotoxaemia. Rupture of the ovarian and/or replaced carefully starting with the vagina, then the
uterine arteries often leads to abdominal pain and cervix, and finally the uterus itself. It is important
rapid death. Any concurrent damage and/or infection not to use finger pressure, but to keep the hands flat
will have a negative effect on the mare’s future fer- in order to avoid punctures or lacerations to the fri-
tility. Rarely, bladder eversion, uterine rupture and able uterus. Covering the uterus with a plastic bag
intestinal herniation can occur and seriously alter the helps to decrease the incidence of damage. When the
prognosis. Invagination of the tip of the uterine horn uterus returns back into its abdominal position it is
may present as abdominal pain due to traction on the essential that it is completely reduced, particularly at
ovary or it may be subclinical and only detected on the tips of the horns, otherwise re-prolapse and/or
subsequent routine fertility examinations. damage to the tips may occur. This can be achieved
by filling the uterus with warm clean water or, pref-
Diagnosis erably, saline if the clinician’s arms are not long
Diagnosis is made on clinical signs and rectal/vagi- enough to reach the tips of the uterus. Irrigation of
nal palpation. the uterus and removal of the fluid will also further
reduce contamination and the risk of septic metri-
Management tis. Once reduction is complete (check per rectum)
Complete prolapses are emergency cases and require small doses of oxytocin (10–20 IU q2 h) will improve
immediate attention. The uterus should be pro- uterine involution. Intrauterine antibiotic/saline
tected as much as possible to prevent further dam- solutions are used by some clinicians. If the placenta
age. Often the mare is distressed and in pain, which is still retained, specific therapy should be insti-
may lead to further self-damage to the uterus. The tuted. Some clinicians advocate suturing the vulva
mare should be restrained and kept quiet, with the to prevent re-prolapse, although it is more likely it
use of sedatives/analgesics only if these are essential prevents a pneumovagina. Recurrence is unlikely
(drug-induced hypovolaemia may cause the mare unless the uterus is not completely reduced or there
to collapse). Systemic antibiotics (including oral is persistent straining for other reasons. Any bowel