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Parturition

Rachael Jones Reproduction - CVS1 Inglés 112 fichas

Fichas del conjunto (112)

  1. 1What is premature lactation is often associated with in the horse?Placentitis
  2. 2What are the udder secretion electrolytes changes that can be used to predict impending parturition?Increased Ca
    Increased K
    Decreased Na
  3. 3If there is a normal parturition in the mare, how can the process be described?Quick
  4. 4What is one consequence of placentitis?Failure of passive transfer - due to premature lactation and therefore lack of colostrum
  5. 5What can be used to help predict parturition?• Date conception
    • Estimate fetal age
    • Relaxation pelvic ligament
    • Examination mammary glands
    • Mammary secretions
    • Foaling alarms
  6. 6What is the gestation of the mare?11 months and 11 days
    - 12 months is acceptable
  7. 7How can you estimate the fetal age?Fetal eye size done with Ultrasound but only reference ranges for TB
  8. 8How can foaling alarms be used?- Recumbency or sweat
    - Recumbency ones show the owner when the horse is lying down so false positives when have a sleep
    - Horses sweat when giving birth and so the alarm goes off, can also get false positives when horse messes with the water bucket
  9. 9Are foaling alarms useful?- Yes generally
  10. 10What are the milk electrolyte changes that occur before parturition?↑Calcium ↑Potassium ↓Sodium ↓pH
  11. 11How do the calcium levels change before foaling?Steep incline in 12-24h before foaling
    • > 200ppm (40mg/dl) then 84% of foaling within 48 hrs
  12. 12What are the commercial kits available to monitor milk electrolyte changes?• Predict-a-foalTM
    • FoalWatchTM
    • ?water hardness tests - to monitor calcium lime scale
  13. 13When is it useful to monitor milk electrolyte changes?When have an expensive mare and so you know when to monitor her closely
  14. 14What is the duration of stage 1 labour?1-4 hours (the longest stage in the mare)
  15. 15What occurs is stage 1 labour?• Onset uterine contractions
    • Mild colic signs (uncomfortable, constantly up and down)
    • Foal enters pelvis
    • Cervix will be opening
    - Large variation in timing and clinical signs
  16. 16How should you prepare for foaling during stage 1 labour?- Bandage tail
    - Wash perineum
    - Reverse caslicks if not already be done
  17. 17What is the duration of stage 2 labour?5-25 mins
  18. 18What occurs in stage 2 labour?• Abdominal contractions - Explosive, powerful
    • Chorioallantoic membranes rupture - At cervical star
    • Amnion is exteriorized
    • Foal delivered
  19. 19What is the chorioallantoic membrane?- Thick and meaty
    - Attached to mare
  20. 20What is the amnion?- Thin and white
    - What is seen first
  21. 21Give 3 things that can affect foaling.• Presentation (foal direction - head or bum)
    • Position (relative spines - foal compared to mum)
    • Posture (limbs)
  22. 22What is the ideal presentation, position and limb position for foaling?- Anterior presentation - head first
    - Dorsal position - spine of foal next to spine of mare
    - Limbs extended - most
    This would give 2 toes and a nose presentation
  23. 23What is the duration of stage 3 labour?3 hours
    - Any longer then need to intervene
  24. 24What occurs in stage 3 labour?• Expulsion foetal membranes
    - Allantochorion (meaty, needs assessing)
    - Lochia (foetal fluid)
    • Mild uterine pain
    - Uterus starts to contract
  25. 25What is it classed as if stage 3 of labour lasts longer than 3 hours?Retained foetal membranes
  26. 26What should occur immediately post partum?• Minimal human interference ideal: Bonding important
    • If mare had assistance: bring foal to her head
    • Within 5 minutes righting reflexes present: foal will start making attempts to stand
  27. 27What should foals have from birth?Good sucking reflex
  28. 28What happens with the mare post partum?• Uterine involution rapid
    • Vulval discharge 3-4 days
    • Foal heat 5-9 days
    • Breed on foal heat?? - less now, depends how quick you want her back in foal
  29. 29What can help to remove vulval discharge?Turn her out - get her moving more
    - Will mean the abdominal muscles contract more and therefore getting the fluid out
  30. 30What are the rare occasions when parturition can be induced?• Rupture pre-pubic tendon - ventral oedema, foal will be early, done to reduce mare fatality
    • Hydrops uteri
    • Overdue and small foal
    • Uncomfortable + open cervix - risk of ascending placentitis
  31. 31How do you induce parturition?- Lose dose oxytocin:
    - 10 i.u every 20 mins
    - Or daily doses when imminent (calcium above 40mg/l (over 200))
  32. 32What else can be used to help induce parturition?PG cervix
  33. 33Who is at greater risk with induction of parturition?Foal
  34. 34Where should induction of parturition take place?In hospital - due to being associated with complications
  35. 35What is premature placental separation?• “red-bag delivery”
    - Placental separation, pass placenta first and so no oxygen to the foal - Foal dies
  36. 36What occurs in premature placental separation?• Predisposed to when labour induced
    • Emergency- get foal out asap
    • Foal supplemental O2
    • High risk perinatal asphyxia syndrome - "dummy foal"
  37. 37What is dystocia?Impediment to normal delivery of foal
  38. 38What can cause dystocia in horses?Maternal:
    • Uterine torsion
    • Pelvic fracture - bony calus in the way
    Foetal:
    • Size - rarely as size is determined due to the uterine surface area of mare
    • Malpresentation - 40% due to head back
    • Mutation - Hydrocephalus, limbs fused
  39. 39What should you do when you get a call about a dystocia?• Advise owners keep the mare walking, put on tail bandage
    • Drive directly & immediately OR get the mare to hospital asap
  40. 40What is the risk to the foal in dystocia?Asphyxia or hypoxia
  41. 41What is usually the case when you arrive at a dystocia?Live foal when arrive
  42. 42What is the incidence of dystocia?1% - 4% in TBs
    10% in drafts
  43. 43What is the issue with dystocia?It's stage 2 labour which determines whether the foal lives or dies and this is the quickest stage and therefore don't have a lot of time to act
  44. 44When is a parturition classed as dystocia?• No amnion or foal at vulva within 5 mins of allantochoroin rupture
    • No strong contractions within 10 mins of allantochoroin rupture
  45. 45What is indicated with dystocia?Vaginal exam
  46. 46How can you tell if the labour has been going on for some time with a dystocia?If any of the foal is presented it will be dry
  47. 47What are the options to deal with a dystocia?• Vaginal assisted delivery
    • Controlled vaginal delivery
    • Caesarian section
  48. 48What is the choice of treatment for dystocia decided by?• COST
    • Live foal/dead foal
    • Owner
    • Vet
    - Use of mare and how valuable, whether foal or mare is more important
  49. 49What is the main concern with vaginal assisted delivery?Takes time - is that wasting time? Potentially
    - How long do you try and reposition the foal for...
  50. 50What are the rules for vaginal assisted delivery?• IF NO PROGRESS in 5mins REFER
    • IF MAKING PROGRESS: Frequently stop and reassess
  51. 51What do you do with a assisted vaginal delivery?• Sedate mare
    • Maintain hygiene - endometritis
    • LUBRICATION
    • Clenbuterol - B2 agent, stop uterine contractions and allows for reposition
    • Consider epidural? takes time to place, wobbly on hindlimbs, don't want if planning to travel
  52. 52How do you deliver the foal in vaginal assisted delivery?• Identify fore/hindlimbs
    • Rope limbs: To pull on
    • Rope head: To guide position, NOT to apply traction to
    • Pull downwards
    • Pull in synchrony with uterine contractions
    • Foal catchers if standing
  53. 53What happens with a controlled vaginal delivery?• Deliver foal per vaginum
    • Mare anaesthetised
    • Elevate hindlimbs
    • Allows repositioning without contractions
    impairing
    - At the same time, another time preparing for the C-section
  54. 54What is an Episiotomy?A surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues - prevents common opening with anus
  55. 55What should you do if caslick's were previously performed?• Reverse (incise) ~2w before birth
    • When udder develops
    • Daily Vaseline - better seal and catches faeces preventing going in vagina
    • If appalling conformation: Few large sutures easy to remove
  56. 56At what position do you incise for an episiotomy?1 or 11 o’clock or both
  57. 57What is the issue with Caesarian sections in the UK?Very poor statistics for live foals due to distance that has to be travelled to get to hospital
  58. 58What is the usual combination of drugs for anaesthetising the mare?xylazine, ketamine, isoflurane (less supressive than halothane)
  59. 59What are the teams that are found for a C-section?• Surgeons - Mare
    • Medics – Foal resuscitation
  60. 60What is the main issue with the C-section?- COST
    - Lots of post operative intensive care fro mare and foal usually
  61. 61When is an embryotomy used?• Dead foal and need to cut it up to deliver it
    • Experienced clinician
  62. 62What is the main concern with the embryotomy?- Huge risk of damage so great care needs to be taken
    - Single incision is best and reduces the risk
  63. 63What tool should be used for an embryotomy?Foetotome
  64. 64What should the foal be able to do from birth?• Standing up within 2h
    • Suckling within 3h
    - Investigate if not and stomach tube colostrum
  65. 65What does the mare need closely monitoring for after dystocia?• DUDE (drinking, urinating, defecating, eating)
    • Lactation - Tx Domperidone
    • Pain – Tx NSAIDs
    • Laminitis
    • Endotoxic shock
    • Peritonitis
  66. 66What can be done if it all goes wrong?• Fostering is an option
    - Pick a good mum
    - TB mares not easy
    • Camouflage smell
    - Vicks in their nose
    - Dead foal skin/placenta as coat
  67. 67What is the main issue related to fostering?Care with agreement (written) between owner of foal and owner mare – who pays for what
    - Often done in an emergency and so not done properly and so leading to disputes
  68. 68What are potential post partum problems?• Retained Foetal Membranes
    • Trauma- vulva, vestibule, vagina, cervix, perineum, uterus, rectum, anus
    • Uterine rupture/ haematoma/ prolapse
    • Rupture utero-ovarian artery
    • Hypocalcaemia
    • Metritis
    • Mammary gland issues
  69. 69What is essential with all placentas after parturition?They are inspected for integrity and entirety
  70. 70What section of the placenta is likely to be retained?Non pregnant horn if torn
  71. 71What is retained foetal membranes?• Chorioallantois >3hours
    • Incidence 2-10%
    • (50% post c-section)
  72. 72What should be done if the foetal membranes are hanging out?- Fold up and tie due to not weighted, and will prevent trauma and so aids in assessment after delivery
  73. 73What are the treatment options for retained foetal membranes?• Manual traction - twist them as makes stronger and prevents tearing
    • Oxytocin drip/bolus
  74. 74What should be done post removal of retained foetal membranes?• Lavage - reduce contamination
    • Oxytocin bolus
  75. 75What can occur if retained foetal membranes are untreated/ unidentified?• Endometritis
    • Laminitis
    • Shock
    • Death
  76. 76What are 1st degree and 2nd degree perineal lacerations and how should they be treated?• 1st degree- vulval lips
    • 2nd degree- vulval lips and muscle layers
    • Repair at the time or Delay repair until swelling subsided
  77. 77What has occurred with 3rd degree perineal lacerations?- Common anal-vaginal opening and no membrane inbetween
    • damage vaginal roof, rectal floor & perineum
    • Recto-vaginal fistula - intact anal sphincter but communication cranial to it
    • Faecal contamination vagina
  78. 78How can 3rd degree perineal lacerations be treated?• AB’s, NSAID’s, laxative diet
    • Delayed repair
    • No breeding that season
    - Chronic endometritis and poor fertility can be the outcome
  79. 79What should happen if there is vestibular and vaginal trauma?• Usually too swollen to suture immediately
    • Resolve the problem before covering
    - Caslick's
  80. 80What is the issue with cervical trauma?- Rare but serious consequences for future fertility
    • Fibrosis leading cervical incompetence
    • Full thicknesss tears sutured 4-8 weeks
    • Warn - poor fertility
  81. 81When is the best time to look for cervical trauma?In dioestrus
  82. 82What happens if there isn't a good cervical seal?Lead to ascending placentitis - premature lactation etc
  83. 83What happens if there is a small, dorsal uterine rupture?Manage conservatively
  84. 84How should a large/ventral uterine rupture be treated?Surgical emergency
  85. 85What is the issue with uterine rupture?COST
    - need to differentiate from rectal prolapse/tear
  86. 86How does uterine haematoma present?• Presents as post partum colic
    • Diagnosis made using rectal palpation and US
    • Usually heals without complication
  87. 87Do uterine haematoma usually have long term consequences?No
  88. 88What is the issue with ruptured ovario-uterine artery?- Bleed into broad ligament - tends to be fine
    - Bleed into the abdomen -> die
    - Severe colic
  89. 89How can you diagnose and treat ruptured ovario-uterine artery?• Diagnosis on clinical signs and US, paracentesis of fluid
    • Treatment
    - Autotransfusion/ blood transfusion
    - ?Formalin IV -> USA
    - Antifibrinolytics (aminocaproic acid)
  90. 90What is related to uterine prolapse?• Rare, diagnosed by presentation
    • Fatal haemhorrhage possible
  91. 91How do you treat uterine prolapse?• Lavage thoroughly
    • Feed in gently + lavage large volume fluid
    • Treatment: ABs NSAIDs, Calcium,
    • no oxytocin
  92. 92What is hypocalcaemia usually?Stress related
  93. 93How does hypocalcaemia present?• Hyperaesthesia + dry faeces
    • Spontaneous diaphragmatic flutter (Thumps) - phrenic nerve stimulated causing RR and cardiac rate to be the same, breathe as heart beats and rib movement not in sync with breath
    • Recumbency and tetanic spasms
  94. 94How do you treat hypocalcaemia?• Slowly infuse Ca borogluconate then give ongoing IV fluids
  95. 95What does hypocalcaemia predispose to?Post partum colic
  96. 96What does post partum metritis lead to?• Significant cause poor fertility
    • Risk laminitis/ endotoxaemia
  97. 97What is the treatment for post partum metritis?• Copious lavage
    • Topical +/- systemic ABs
    • NSAIDs
    • Polymixin B if endotoxaemia
    - Oxytocin/ PGs - for contractile effect
  98. 98What are problems that can occur in relation to the mammary glands?• Agalactia
    • Mastitis
    • Premature lactation
  99. 99When does agalactia occur?Usually primiparous mares (first time mum)
  100. 100What is the mechanism for causing agalactia?• Ingestion ergot alkaloid, dopamine antagonist
    • Poor nutrition
    • Pain??
    • Serum prolactin decreased
  101. 101How do you treat agalactia?• Domperidone, metaclopramide - to increase the prolactin
  102. 102How can mastitis present?• Owner may think lame - stiff to walk
    • Hot, swollen, painful (CARE- can kick)
    • Occasionally + systemic signs
  103. 103How do you diagnose mastitis?• Presentation
    • Milk- cytology / culture
    - Usually Streptococcus zooepidemicus
  104. 104How do you treat mastitis?• Milk out
    • Intramammary preparations (cows)
    • Hot pack
    • NSAIDs
    • Systemic Abs, TMPS/ Penicillin
  105. 105What must you always do with premature lactation?Always check CTUP for placentitis
  106. 106What is the issue with premature lactation?• Potential for failure of passive transfer in foal
  107. 107How can you get round premature lactation?• Collect colostrum
    - store in fridge
    - stomach tube foal
  108. 108When is the bonding time between mare and foal most critical?1st 6 hours
  109. 109What is the issue with foal rejections?• Risk FPT +/- trauma to foal
    • More likely:
    - Maiden
    - Dams reared in isolation
    - Arab mares
  110. 110What can be the cause for foal rejection?- Pain in dam, potentially mammary glands?
  111. 111How do you treat foal rejection?• Don’t punish mare
    • Treatments:
    - Aggressive mares- altrenogest
    - NSAIDs
    - Oxytocin, hand milking
    - Sedation ACP
  112. 112What are factors that put the foal at risk?• Any cause of poor colostrum intake increases risk FPT and therefore risk sepsis
    • Mare factors- not allowing/able sufficient colostrum
    • Foal factors- PAS, angular limb deformities (severe), flexor tendon contractures, premature/dysmature

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(Equine reproduction - Jenny Mason) Reproduction - CVS1 Fichas sobre Parturition, creado por Rachael Jones el 13/03/2018.
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