Uterine torsion and uterine tear in a mare.

A 15-year-old Standard-bred mare was examined because of signs of abdominal discomfort in late gestation. Palpation per rectum revealed tight broad ligaments above and below the uterus, with the right broad ligament running across the top of the uterine body down toward the left, ventral side of the abdomen. A diagnosis of counterclockwise uterine torsion was made and surgical correction was approached via a left, flank laparotomy with the horse standing. The uterus was repositioned and a uterine tear encompassing 180 degrees of the uterine surface was found in the lateral, uterine body just cranial to the cervix. A live colt was delivered vaginally after uterine repositioning and the laparotomy incision was closed. The uterine tear was then repaired via a blind, vaginal approach. The mare was discharged 10 days after surgery. Repair per vaginum of a uterine tear is presented as an alternative treatment in cases for which the tear is recent, abdominal contamination is minimal, and the tear is easily accessible from the vaginal approach.     

Hydramnios causing uterine rupture in a mare

An 18-year-old mare, 285 days pregnant, was evaluated for apparent abdominal pain of 8 hours' duration. A large volume of sanguinous fluid was obtained on abdominocentesis, and digital vaginal examination revealed a dilated cervix and blood in the uterus. Abdominal palpation per rectum revealed the uterus to be large and distended with fluid. Ultrasonography revealed a dead fetus on the floor of the cranial portion of the abdomen. The mare was euthanatized, and necropsy confirmed that the uterus had ruptured, and that the fetus, within its chorioallantois, was in the abdomen. The amniotic sac contained approximately 96 L of amniotic fluid. Torsion of the amniotic sac separated the fetus from the fluid-filled compartment. Hydramnios was diagnosed on the basis of the excessive amniotic fluid and was believed to be the cause of the uterine rupture.     

Uterus unicornis in two mares

Two American Paint Horses, a 3-year-old nulliparous mare and a 7-year-old primiparous mare, presented for recent infertility and a pre-breeding examination, respectively. Examination of the internal reproductive tract of both mares using transrectal palpation and ultrasonography revealed the presence of the cervix, uterine body, left uterine horn and bilateral ovaries. The right uterine horn could neither be palpated nor imaged. The clinical diagnosis of uterus unicornis in one mare was confirmed at necropsy, which revealed combined aplasia of the right uterine horn and oviduct.     

Metallic foreign body in the ovary of a broodmare

A 12‐year‐old Thoroughbred broodmare was presented for laparoscopic removal of an abnormal ovary. Rectal examination and ultrasound revealed firm attachment of the enlarged right ovary to the ventral pelvis and right abdominal wall, and gas accumulation within the right ovary. Laparoscopic examination revealed extensive adhesion formation between the abnormal ovary, ispilateral uterine horn, ventral pelvis and the right abdominal wall. A flank laparotomy was then performed to improve visualisation of the area. Due to contamination of the abdomen during attempts to detach adhesions, the complexity of the structures involved and the poor prognosis for further reproduction, the decision was made to subject the mare to euthanasia. Post‐mortem evaluation revealed a large encapsulated abscess of the right ovary, with a small, linear wire foreign body within the centre of the abscess.     

Removal by laparoscopic partial ovariohysterectomy of a uterine leiomyoma assumed to have caused fetal death in a mare

A 13‐year‐old pluriparous Dutch Warmblood mare presented to Utrecht University's Department of Equine Sciences 4 weeks after suspected abortion at 3.5 months gestation, to investigate the nature of a uterine mass and persistent vulval discharge. Transrectal ultrasonographic examination revealed copious flocculent fluid and fetal remnants within the uterus and a 5–6 cm heterogenous mass in the uterine wall at the tip of the right horn. Expulsion of fetal parts and resolution of the coexisting endometritis were effected by a combination of repeated PGF_2a analogue injections to induce oestrus, application of PGE₂ gel to aid cervical relaxation, and daily uterine lavage and antibiotic instillation. The presence of the mass in the uterine wall was confirmed by hysteroscopy and the suspected tumour subsequently removed by partial laparoscopic ovariohysterectomy under standing sedation and local anaesthesia. The histological appearance of the tumour was consistent with a leiomyoma or moderately malignant leiomyosarcoma. Although a follow‐up examination 6 months post surgery revealed uncomplicated healing of the uterus, the owner decided to retire the mare from breeding. Uterine neoplasia is an extremely unusual cause of fetal death in the mare but, in the present case, laparoscopic partial ovariohysterectomy proved a promising, minimally invasive technique for salvaging sufficient uterus to make subsequent breeding a realistic proposition.     

Torsion of the uterus--a cause of colic in the mare.

A case of uterine torsion in a mare with colic is described in which an early diagnosis was made and the torsion successfully reduced through a standing laparotomy with survival of both the mare and the foal. This case is used to stress the importance of thorough examination of all pregnant mares with colic in order to differentiate uterine torsion from other causes of abdominal pain, thereby avoiding delay in surgical correction and reducing the risk of fetal and/or maternal death. The advantages of the standing laparotomy are presented in support of this method of treatment of torsion of the gravid uterus.     

Torsion of the Uterus — A Cause of Colic in the Mare

A case of uterine torsion in a mare with colic is described in which an early diagnosis was made and the torsion successfully reduced through a standing laparotomy with survival of both the mare and the foal. This case is used to stress the importance of thorough examination of all pregnant mares with colic in order to differentiate uterine torsion from other causes of abdominal pain, thereby avoiding delay in surgical correction and reducing the risk of fetal and/or maternal death. The advantages of the standing laparotomy are presented in support of this method of treatment of torsion of the gravid uterus.     

Fetal maceration and retention of fetal bones in a mare

A 19-year-old Quarter Horse mare was evaluated because of bloody vaginal discharge that was apparent immediately following breeding. On transrectal ultrasonography, it was evident that the uterus was filled with fluid containing echogenic particles; linear hyperechoic structures were also visible. Endoscopy was performed, which revealed a number of bones adhered to the cranial wall and floor of the right uterine horn as well as purulent fluid in both uterine horns. Bacterial endometritis and fetal maceration were diagnosed. The mare was treated with antibiotics, and the fetal bones were manually removed from the uterus. Fetal maceration with intrauterine retention of bones is rare in mares. Use of hysteroscopy supplements ultrasonography in the diagnosis of uncommon conditions of the uterus. Macerated bones may be adhered to the endometrium, thereby requiring manual removal.     

Clinical signs and treatment of chronic uterine torsion in two mares

Two mares were evaluated because of chronic uterine torsions of 2 and 4 weeks' duration; both were pyrectic, anemic, tachycardic, and anorectic, had signs of depression, and had an abnormal uterus and contents on transrectal examination. Both mares underwent cesarean section for lysis of adhesions from the uterus to the peritoneum, correction of the torsion, and ovariohysterectomy Both mares recovered with only minor complications and returned to be used as riding horses. Chronic uterine torsion should be considered in mares in late stages of gestation that have vague clinical signs and transrectal palpation findings that are unlike those described in typical cases of uterine torsion. Prognosis for life can be good after treatment by ventral midline celiotomy, cesarean section, correction of the torsion, and ovariohysterectomy.     

Ovariohysterectomy in Six Mares

Six mares had ovariohysterectomy performed for chronic pyometra associated with cervical abnormalities, uterine neoplasia, or removal of a macerated fetus. Ovariohysterectomy was performed through a ventral midline incision with access to the ovarian and uterine vessels aided by traction on the uterus and retraction of abdominal viscera. Abdominal pain, the most common complication after surgery, occurred in four mares but resolved within 36 hours. Peritonitis occurred in two mares; one mare was subsequently euthanatized. Other complications that resolved with treatment included infection of the uterine stump (two mares), abdominal hemorrhage (one mare), diarrhea (one mare), and incisional infection (one mare). Complications after surgery can be reduced by removing as much of the uterus as possible, minimizing peritoneal contamination with uterine contents, and providing a secure closure of the caudal reproductive tract.     

Effect of surgical manipulation, placental fluid, and flunixin meglumine on fetal viability and prostaglandin F2 alpha release in the gravid uterus of mares

Twenty-one pregnant mares with single or twin conceptuses between 41 and 65 days of gestational age were allotted to 5 treatment groups. A ventral median celiotomy was performed in all mares. In group-1 mares (3 mares, single conceptus), the uterus and fetus were palpated for 5 minutes. In group-2 mares (3 mares, single conceptus, flunixin meglumine), 250 ml of sterile placental fluid was injected into the nongravid uterine horn. In group-3 mares (4 mares, unicornuate twin conceptuses), group-4 mares (3 mares, unicornuate twin conceptuses, flunixin meglumine), and group-5 mares (8 mares, bicornuate twin conceptuses, flunixin meglumine), 1 conceptus was removed from the uterus via hysterotomy. All mares received progesterone prophylactically until day 100 of gestation or until the fetus died. The 3 mares in group 1 delivered clinically normal, live foals. The mean prostaglandin F2 alpha metabolite (PGFM) plasma concentration peaked at 180 +/- 5.2 pg/ml during uterine manipulation and fetal palpation, then declined to baseline by 1 hour. Free placental fluid (group 2) undermined the chorioallantois ventrally and resulted in fetal death within 3 hours after surgery. The mean PGFM plasma concentration peaked at 39 +/- 4 pg/ml following injection of placental fluid. None of the remaining fetuses in the 7 mares with unicornuate twin conceptuses (groups 3 and 4) survived. Five mares with unicornuate twin conceptuses (group 5) delivered single viable foals. In another mare in group 5, the fetus was alive 4 days after surgery, when the mare was euthanatized for a fractured femur.(ABSTRACT TRUNCATED AT 250 WORDS)     

Renal failure in a pregnant mare

Although chronic renal disease is uncommon in horses, guidelines for management of the broodmare with kidney disease are needed to ensure successful foaling. Herein, we present a case report of a broodmare with chronic renal disease that produced a live foal, and parturition was predicted by monitoring pH and electrolytes in the milk. A 15-year-old pregnant mare presented with a history of poor body condition and weight loss despite an excellent appetite. At presentation, the mare was bright, alert and responsive, with severe pitting ventral oedema and vital parameters within normal limits. Plasma biochemistry revealed azotaemia, hypercalcaemia and hypophosphataemia. Based on clinical ultrasonographic and biochemical parameters, the mare was diagnosed with renal failure. Pregnancy was assessed by transabdominal ultrasound, and the fetal parameters were within normal limits; however, an increased combined thickness of the uterus and placenta and oedematous fetal membranes were found. Monitoring of mammary secretions accurately predicted the onset of foaling at 326 days of gestation. A healthy filly was delivered, and the fetal membranes were passed in a timely manner without complications. Physical examination and haematological parameters were within the normal limits for a neonate foal, except for a mild elevation in blood urea nitrogen. Two weeks later, the mare was subjected to euthanasia due to worsening of her condition. At necropsy and on histopathological examination, the findings were consistent with chronic renal disease. This case demonstrates that a pregnant horse with chronic renal disease can be managed with supportive care and produce a viable foal. Fetal well-being and mare’s prefoaling milk electrolytes were similar to parameters measured in healthy pregnant mares, suggesting that the feto-placental unit may be spared of the dam’s systemic disease. Prepartum physiological changes in the milk may be unaltered with concurrent maternal renal disease and still be useful for foaling prediction.     

Standing laparoscopic-assisted vaginal ovariohysterectomy in a mare

A 20-year-old Arabian mare presented to Washington State University Veterinary Teaching Hospital for evaluation of haemorrhagic vaginal discharge of 3 months' duration. The referring veterinarian had identified a mass within the uterine wall via transrectal ultrasonographic examination. On presentation, the mare had an unremarkable physical examination with the exception of a mild haemorrhagic vaginal discharge. Rectal palpation was performed and an approximately 9 cm diameter mass with a granular texture was identified associated within the uterine body and left uterine horn. Endoscopic examination of the reproductive tract revealed a linear defect in the ventral uterine wall near the cervix with direct communication into the abdomen. Standing laparoscopic-assisted vaginal ovariohysterectomy (OHE) was performed, which involved laparoscopic facilitated dissection and haemostasis of uterine and ovarian structures, and inversion of the uterus through the cervix. Removal of the uterus was performed vaginally. No post operative complications were noted. Standing laparoscopic-assisted vaginal OHE is an alternative to traditional OHE techniques. This technique allowed for excellent direct visual observation during dissection and ligation and did not require general anaesthesia.     

Management of hydrops amnion in a mare resulting in birth of a live foal

CASE DESCRIPTION: A 19-year-old Thoroughbred mare was evaluated at 265 days of gestation with a markedly distended abdomen and edema of the ventral portion of the abdomen. CLINICAL FINDINGS: The uterus was distended over the pelvic rim, making transrectal palpation of the fetus impossible. Transabdominal ultrasonography revealed excessive amounts of fetal fluid. Results of analysis of fluid obtained via amnio- and allantocentesis confirmed that the amniotic cavity was large. TREATMENT AND OUTCOME: The mare was monitored for signs of weakness of the prepubic tendon and abdominal wall. The fetus and placenta were monitored for signs of stress and pending abortion. Flunixin meglumine and altrenogest were administered to the mare. Parturition was attended and occurred at 321 days' gestation. Postpartum complications in the mare included hypovolemic shock and cardiac arrhythmias. Both conditions were treated, and the mare recovered. The foal was considered small, had bilateral angular limb deformities, and was unable to nurse. The foal was given plasma for failure of passive transfer of immunity. Ten months later, the foal underwent procedures to correct limb deformities. CONCLUSIONS AND CLINICAL RELEVANCE: Hydrops conditions are rare in horses, with hydrops allantois occurring more frequently than hydrops amnion; reportedly result in fetal or neonatal death; and may result in death of or injury to the mare. Close monitoring of maternal and fetal health in combination with supportive treatment of the mare can result in the safe progression of a hydrops pregnancy and the birth of a live foal.     

Chronic intermittent colic in a mare attributed to uterine marbles

A 13‐year‐old Quarter Horse mare presented for evaluation of chronic intermittent colic. Following extensive diagnostics, abdominal radiographs revealed two round, radiopaque objects in the caudal abdomen. Palpation per rectum and transrectal ultrasonography of the reproductive tract confirmed that the round objects were uterine marbles. Dinoprost tromethamine (Lutalyse, 5 mg i.m. q. 24 h for 2 days) was administered to bring the mare into oestrus, and both uterine marbles were manually removed from the uterus following digital dilation of the relaxed cervix. Follow‐up with the owner 12 months after discharge revealed that the mare had shown no further signs of abdominal discomfort since having the uterine marbles removed. To the authors' knowledge, this is the first published report of chronic intermittent colic attributed to uterine marbles in a mare.     

The effect of uterine torsion on mare and foal survival: a retrospective study, 1985--2005

REASONS FOR PERFORMING STUDY: Anecdotal speculation suggests that prognosis for survival of mares and foals following correction of uterine torsion has improved over the past 30 years. OBJECTIVES: To determine statistically the outcome of uterine torsion according to duration of clinical signs, stage of gestation, parity, physical examination findings, method of correction, prognosis for survival and reproductive health of the mare, and prospects for the foal within the neonatal period. METHODS: This retrospective study combined cases from 4 equine referral hospitals. RESULTS: The stage of gestation at which uterine torsion occurred was a risk factor for survival of mare and foal. Overall mare survival was 53/63 (84%); when uterine torsion occurred at < 320 days gestation, 36/37 (97%) of mares survived compared to 17/26 (65%) survival rate when uterine torsion occurred at > or = 320 days gestation. Overall foal survival was 54% (29/54). When uterine torsion occurred at < 320 days gestation, 21/29 (72%) foals survived compared to 8/25 (32%) when uterine torsion occurred at > or = 320 days gestation. Thirty mares were discharged from the hospital carrying a viable fetus following uterine torsion correction and 25/30 (83%) of these mares delivered live foals that survived beyond the neonatal period. CONCLUSIONS: Prognosis for survival for mares and foals following uterine torsion is good and improves if torsion occurs < 320 days compared to > or = 320 days gestation. CLINICAL RELEVANCE: Gestational timing of uterine torsion should be considered when advising clients about the prognosis for survival of the mare and foal. The prognosis for a mare delivering a live foal is good if the mare is discharged from the hospital following uterine torsion correction with a viable fetus.     

Septic metritis secondary to torsion of a pedunculated uterine fibroleiomyoma in a filly.

A 2-year-old Arabian filly was referred for evaluation of a serosanguineous vaginal discharge. Palpation per rectum revealed a large, fluid-filled uterus and a uterine mass. The filly developed septic metritis and secondary laminitis as a result of torsion and necrosis of a pedunculated uterine mass. Ovariohysterectomy was performed. The entire cervix was removed with the uterus. Gross examination of the excised uterus revealed 3 intraluminal masses. Histologic evaluation identified the tumors as fibroleiomyoma. The filly recovered completely, and there was no recurrence of the tumor.     

Use of a hand-assisted laparoscopic technique for removal of a uterine leiomyoma in a standing mare

A 20-year-old Thoroughbred mare was evaluated because of a 2-year history of infertility. The mare had normal estrous cycles and had been bred 7 times by different stallions. Ultrasonographic examination revealed a homogeneous hyperechoic intramural mass in the tip of the right uterine horn; the mass was also detected via hysteroscopy Unilateral ovariectomy and partial hysterectomy were performed by use of a hand-assisted laparoscopic technique. Leiomyoma was diagnosed via histologic examination of the mass. Unilateral ovariectomy and partial hysterectomy are recommended in mares with leiomyoma in a uterine horn, especially if the tumor is associated with infertility. The hand-assisted laparoscopic technique allows direct visualization of abdominal structures and accurate placement of ligatures without applying tension on the broad ligament, and eliminates the risks and costs of general anesthesia.     

Permanent Lateral Deviation and Stenosis of the Cervix in an Infertile Jennet

Congenital abnormalities of the uterus and the cervix are rare in horses, often associated with infertility, despite normal ovarian activity and sexual behaviour. An abnormality of the cervix in a 5‐year‐old jennet with a history of infertility was described. Clinical and ultrasound examination of the genital tract showed a normal development of the uterus with regular cyclic activity in both the ovaries. Vaginoscopy revealed a normal development of the vagina and a cervix deviated on the left side of the vagina by a thick dorsoventral fold. The lateral deviation was permanent in any stage of oestrus cycle. Furthermore, the cervical os was narrow and digital penetration was not realizable. Using a 5‐mm catheter, the full penetration was not possible even during oestrus; moreover, the inoculation of fluid could be revealed in uterus by ultrasound (fluid was not present before inoculation), demonstrating a minimal patency. An abnormal and permanent lateral displacement of a stenotic cervix was suspected as the primary cause of infertility in the jennet.     

Prenatal Diagnosis of Megacystitis and Hydronephrosis in an Equine Fetus: How Transabdominal Ultrasonography Can Help to Diagnose Fetal Abnormalities

Premature udder development constitutes an alarm signal in pregnant mares. The objective of this clinical case report is to highlight the importance of transabdominal ultrasound examination of the fetus in these cases and to report a unique case of prenatal diagnosis of obstructive uropathy based on the observation of severe fetal hydronephrosis and megacystitis in utero. A 4-year-old French chaser primiparous mare was referred for evaluation of premature udder development during the ninth month of pregnancy. The mare had clinical signs within normal limits, a developed and sensitive udder with secretions, and no vulvar discharge. Transrectal examination revealed the presence of an immobile fetus. Combined uteroplacental thickness was within normal limits. Transabdominal ultrasound revealed a single live fetus in posterior presentation with several abdominal abnormalities. Unilateral hydronephrosis and megacystitis lead to a hypothetical diagnosis of fetal multiple urinary tract malformation with outflow obstruction. Treatment was discontinued and the mare was monitored. Abortion occurred spontaneously a week later. Postmortem examination revealed a ruptured bladder of abnormally large dimensions and a severely distended left kidney without parenchyma (filled with free urine) and lack of permeability in the left ureter and urethra. Postmortem diagnosis was consistent with our prenatal ultrasonographic diagnosis. Even though described during human pregnancy with various etiologies and severity, prenatal diagnosis of fetal hydronephrosis and megacystitis has not been reported in equine veterinary medicine before. These malformations need to be characterized more precisely in the future. This case highlights the importance of transabdominal ultrasonography to detect equine fetal abnormalities.