Page 499 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

474 CHAPTER 2

VetBooks.ir can lead to cervical canal distortion or obstruction. emollient cream is applied liberally to minimise
infection and adhesions. Most lesions epithelialise by
Adhesions have also been recorded where the repro-
ductive tract, usually the uterus, has been infused
very large. Freshly formed adhesions can be manu-
with irritant or caustic solutions such as iodine-based the first post-partum oestrus, except those that are
compounds, which damage the lining mucosa. In ally broken down, followed by twice daily manipula-
some cases the muscular layers of the cervix can be tion of the cervix and application of an antibiotic/
damaged, whereas the mucosal layers are not, or they corticosteroid ointment for 7–10 days. This prevents
may heal very quickly. These injuries can lead to cer- their re-formation and encourages healing of the
vical incompetence. In the worst injuries, the muco- exposed areas of submucosa. More chronic adhe-
sal and all muscular layers are damaged, leading to a sions, especially those that have caused physical
cervical laceration, which is usually wedge shaped in deformation, require surgical resection and these
the cervical body (base at the external os). Injuries have a high tendency to recur.
that affect the function of the cervix may lead to Partial-thickness tears or small full-thickness
infertility by obstructing the lumen or, more usually, tears can heal spontaneously by second intention,
by preventing adequate closure. Transluminal adhe- but a check on the integrity of the cervix should
sions can be associated with chronic endometritis and be made at the dioestrous period after the second
pyometra either as cause or effect. Congenital abnor- post-partum oestrus, and mares should be moni-
malities and neoplasia of the cervix are rare. tored carefully for signs of incipient placentitis
throughout any ensuing pregnancy. Full-thickness
Clinical presentation tears of greater than half the length of the cervix are
Damage to the cervix may be noted at the time of best repaired surgically, no earlier than 4–6 weeks
parturition or shortly afterwards. On many occa- post partum, when, hopefully, all inflammation has
sions it is not identified until the mare is presented subsided and a healthy granulation tissue reaction is
for failure to conceive, chronic endometritis or a present. This is carried out under standing sedation
failure to maintain a pregnancy beyond 4–5 months. with epidural anaesthesia and long-handled instru-
ments. A three-layer closure is invariably used.
Diagnosis Postoperatively, 3–5 days of systemic antibiotics
Direct observation of the external os of the cervix and daily application of an antibiotic/corticosteroid
is useful, but defects, tears and adhesions are easily ointment help decrease the incidence of exces-
missed if this is used alone. Careful digital palpa- sive scarring and adhesions, which are common
tion using the thumb and index finger with a clean, sequelae. Mares should be checked 30 days postop-
gloved, lubricated hand is the most useful diagnostic eratively for integrity of the repair, as breakdowns
aid. The problems are best identified during dioes- are common. The mare should not be mated for
trus when the cervix is firm and closed, but after a 30 days by AI or 90 days by natural service. There is
traumatic foaling it is often advisable to examine the an increased risk of post-mating uterine fluid accu-
cervix within 3–5 days. Mucosal defects are often mulation if the cervical drainage is inhibited, and
missed as they heal quickly, unless they are large or these mares should receive appropriate treatment
deep. The position and extent of any adhesions or following breeding. The use of exogenous proges-
defects must be recorded. With incompetence it is terone to promote cervical closure is recommended
possible to pass several fingers through the cervix at to help maintain pregnancy.
dioestrus. In more severe cases, before embarking Cervical incompetence is difficult to treat, but
on treatment, it is prudent to assess the rest of the converting the defect into a laceration, by surgical
reproductive tract for normal function. resection of the overlying mucosa and then repairing
it with a similar three-layer closure, can be success-
Management ful. Mares with severe damage to the cervix, which is
Areas of damaged mucosa should be cleansed at least not amenable to repair, have been treated by cervical
daily with clean warm saline before an antiseptic cerclage after early diagnosis of pregnancy.