Page 500 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Reproductive system: 2.1 The female reproductive tr act 475

VetBooks.ir Prognosis onset of pyrexia, depression, dullness, vaginal dis-
charge (often discoloured, reddish brown and fetid),
The prognosis for mucosal damage treated early is
good. Adhesions of the cervix can recur if treated as
increased heart and respiratory rates. Acute lamini-
chronic lesions, and these carry a guarded progno- abdominal pain, decreased milk production and
sis. Partial-thickness or small lacerations can heal tis (p. 70) may develop within 1–5 days (i.e. digital
spontaneously and carry a fair to guarded prognosis. pulse, coronary band heat, bilateral or quadrilat-
Surgical repair of full-thickness lacerations is diffi- eral limb lameness). In undiagnosed cases, severe
cult and expensive, with partial breakdown, scarring septicaemia and endotoxaemia ensue, with injected
and adhesions possible complications. Fertility fol- mucous membranes, cardiovascular collapse, shock
lowing successful repair is fair, but recurrence of the and death.
lesion at the next foaling is quite common. Abortion
and premature parturition associated with posterior- Differential diagnosis
pole placentitis are common sequelae. Repeat surgery Colic; large bowel torsion; uterine rupture; uterine
is possible, but more guarded in prognosis. artery rupture.

METRITIS–LAMINITIS– Diagnosis
SEPTICAEMIA COMPLEX Diagnosis is based on history and clinical signs.
Rectal palpation may reveal an enlarged, atonic
Definition/overview uterus, which can be doughy, thickened and pain-
Retained fetal membranes, or any other significant ful, and contain large quantities of fetid fluid.
infection of the uterus following foaling, can lead to Ultrasound examination of the uterus confirms the
absorption of bacterial toxins and septicaemia in the enlargement, with prominent endometrial folds and
mare. Laminitis caused by circulating toxins result- echodense intrauterine fluid +/- retained placenta.
ing in vascular changes is a common sequela. There Bacteriological culture and sensitivity of intrauter-
is a high incidence in heavy horse breeds (Fig. 2.79). ine fluid samples help direct antibiotic treatment,
The progression of symptoms can be alarming and and blood samples for haematology often show a
death can occur in severe cases. Post-foaling metritis neutropenia and toxic cells. Palpation of the feet and
should be classed as a medical emergency. lateral radiographic views are helpful in diagnosing
laminitis.
Aetiology/pathophysiology
Gross contamination and damage to the endome- Management
trium during dystocia, or retained fetal membranes, Immediate, vigorous, uterine lavage with 1–3 litres
can lead to bacterial infection of the endometrium of warmed sterile saline 0.5% solution of povidone–
and myometrium or even the serosal layers of the iodine, using a sterile nasogastric tube and funnel,
uterus. Large volumes of abnormal uterine fluid can is required until the egress fluid is clear in order to
accumulate without visible vaginal discharge. The remove as much debris and toxins as possible. An
endometrium becomes thin and friable, allowing antibiotic solution effective against gram-negative
bacteria and toxins to be absorbed into the mare’s bacteria is instilled into the uterus. The procedure
systemic circulation, causing septicaemia and/or is repeated several times every few hours until there
toxaemia. These toxins cause peripheral vascular is no evidence of uterine debris in the flushings.
changes that may result in laminitis. The most com- Thereafter, it is repeated on a daily basis until the
mon causal organisms are gram-negative bacteria, initial flush is clear and free of debris. The response
particularly Escherichia coli. to treatment can be monitored by the use of serial
ultrasonographic examinations.
Clinical presentation Supportive care for the mare includes broad-spec-
Twelve hours to 10 days after foaling, dystocia or trum systemic antibiotics (including metronidazole),
retained placenta, the mare presents with a sudden NSAIDs (e.g. flunixin meglumine), intravenous fluid