Page 498 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Reproductive system: 2.1 The female reproductive tr act 473

VetBooks.ir 2.79

Fig. 2.79 A Shire mare that has
developed metritis–laminitis–
septicaemia complex after a retained
placenta. The mare is reluctant to
stand and is on a deep shavings bed,
partially supported in slings.

by the use of frog supports (Fig. 2.79). Aggressive Fertility rates are not affected in mares that are
laminitis therapy may be necessary if laminitis treated effectively and quickly.
occurs (see pp. 68–75).
After release, the fetal membranes should be laid CERVICAL INJURIES
out carefully to check for their entirety. If any part
is missing, attempts should be made to determine Definition/overview
whether it is still present in the uterus, using either Most cervical injuries occur at parturition and
sterile intrauterine digital palpation or endoscopy. they vary according to the type and depth of dam-
After passage of the fetal membranes, uterine lavage age. Mucosal defects, adhesions, partial- and full-
should be performed to completely distend all parts thickness lacerations and cervical incompetence can
of the uterus including the horn. This should be all occur to a variable extent and anatomical posi-
performed until the fluid returns clean, and volumes tion in the cervix. Damage may not be noted until
of up to 12–15 litres may be required in total. This the mare fails to conceive or maintain a pregnancy.
will encourage removal of bacteria, fluid, debris and Careful digital palpation of the cervix in dioestrus,
enzymes and should be repeated every 12–24 hours plus vaginoscopy, will detail the type of injury and
until the reflux is clean. The use of intrauterine anti- its extent. Treatment depends on the type and age
biotics is controversial. The mare should receive a of the injury and its extent and anatomical site, but
complete examination of the uterus at the subse- often involves surgical repair.
quent foal-heat oestrous period, including culture
and cytology. The mare should not be bred at the Aetiology/pathophysiology
foal heat. The vast majority of cervical injuries occur as a
result of trauma during parturition. Attempts by the
Prognosis mare or by outside parties to deliver the foal before
In some mares, retention of the fetal membranes adequate dilation of the cervix and/or lubrication,
seems to have little effect on their uterine or gen- as well as dystocia resolved with the use of fetotomy
eral health, but in others it can lead to devastating and/or obstetric manipulation, are common causes
complications and even death. All cases require of injuries. The least serious injuries are mucosal
careful consideration and early treatment if thought defects, which can heal by epithelialisation, but if this
necessary. Cases that are ignored or develop serious is delayed, substantial fibrous adhesions can form.
complications carry a guarded to poor prognosis. With time, organisation and scarring of the tissue