Equine Medicine : Case 1

So, Nottingham continue their habit of trend-setting, with lots of students from multiple vet schools joining in this weeks #vetfinals – welcome aboard everyone!

After a quick warm up and welcome, the evening kicked off with Mark Bowen presenting the first case:

Quickly followed by clarification…

Unusually, no cow vets popped up at this moment to point out that it is in fact a horse, so most things probably can and will go wrong with it and it will likely die no matter what you do with it, so we moved on to some good suggestions. These were summed up nicely:

After discussing possible outcomes, we moved on to how to treat the mare to try and prevent this occurring (other than intra-uterine treatment).

First on the list: flunixin

Next up: antibiotics

Also considered: oxytocin

Anti-endotoxics came up:

So ice vs vasodilation became the next controversial topic:

The suggestions for vasodilation were:

When it comes to ice:

Then came an excellent point about the need for careful use of vasodilators in sick patients:

  1. So, in summary…

  2. I have used some other sources to try and make sure I don’t miss anything!
    – Gary’s 4th year repro lecture – Parturition, dystocia and post-partum events in the mare
    – In Practice: http://inpractice.bmj.com/content/23/2/74.full.pdf+html?sid=8db10273-aba8-4a83-81d4-4e56a1b6fba0
    – http://www.vetmed.lsu.edu/eiltslotus/theriogenology-5361/equine%20pregnancy_2.htm
    – http://books.google.co.uk/books?id=VD3Rz8JaQXkC&pg=PA617&lpg=PA617&dq=post-partum+equine+metritis+antibiotic+choice&source=bl&ots=HzZnPYkbmt&sig=QJqBTMi7-dMqBz4uVPFDRc9fF6A&hl=en&sa=X&ei=mW1sUa-MK-jw0gW86oDoDQ&ved=0CEwQ6AEwBA#v=onepage&q=post-partum%20equine%20metritis%20antibiotic%20choice&f=falseIt counts as retained foetal membranes in the horse if they have not been expulsed after 3h (compared with >24h in the cow… Although can leave lots longer than this in the cow before attempting removal!!) This is also more commonly a problem in heavy horses than in ponies.

    RFM in the horse has some severe sequelae:
    – Metritis
    – Laminitis
    – Sepsis/SIRS

    Therefore, we need early recognition and aggressive therapy!

    The placenta and fetal membranes need to be removed – give oxytocin as a tocolytic to cause smooth muscle contraction and expulsion of fluid from the uterus. This needs to be done in conjunction with lavage of the uterus. Oxytocin can be given IM, IV or in a CRI. If caught very early, manual removal can be very carefully attempted, or the visible membranes filled with saline/attached to a glove filled with water to apply traction.
    Another important thing to remember is that even just a small amount of placenta/FM left behind can lead to the same catastrophic consequences so everything must be carefully examined post-foaling! This is a useful link with lots of photos of membranes (normal and abnormal): http://extension.vetmed.ufl.edu/files/2013/01/Equine-placenta-marvelous-organ-and-a-lethal-weapon-updated-on-Jan-29-2.pdf

    Flunixin should be given at high doses (ignoring ‘anti-endotoxic doses’) – analgesia and COX-blocking.

    Anti-endotoxics: polymixin B and lidocaine CRI are options

    Antibiotics should be used intra-uterine and systemically and need to be broad spectrum
    – Penicillin (Gram positive)
    – Gentamycin (Gram negative)
    – Metronidazole (anaerobes)

    The feet can be supported with a deep bed, frog support placement and icing (possible theories include reduction of toxin delivery or reduction in enzymatic breakdown of the basement membrane) in the early stages, and the horse should be box-rested/hospitalised.

    Vasodilation is an option, but should be used very, very carefully and avoided if the horse is showing any signs of SIRS or hypovolaemia.

    Hypocalcaemia can be a sequelae to SIRS, and can be a factor in RFM, so supplementation of calcium may be required.

    Hope that helps – on to case 2!