cavity, with less tendency for compressive containment of the vascular
lesion.
Hemorrhage usually occurs in multiparous broodmares of middle to
older ages. Decreased serum copper levels have been associated with
periparturient haemorrhage. In some mares hemorrhage is subclinical
and a hematoma is discovered at a later date during a routine
reproductive examination. Each hemorrhagic event can cause fibrosis
and a loss of arterial elasticity.
Diagnosis of suspected uterine artery hemorrhage is determined by the
clinical signs of hemorrhagic shock, palpation of a painful enlarged
broad ligament hematoma, or the presence of a painful hematoma of
the uterine wall. Ultrasound diagnostics are pivotal to assessing the
hemorrhage. Free blood within the abdominal cavity can be observed
as a ‘ground-glass’ echodense fluid that swirls with the motion of
abdominal excursions or visceral movement. Rectal ultrasound can be
useful in confirming the presence of a broad ligament or intramural
haematoma.
The most common differential rule-outs to suspected periparturient
hemorrhage are a tear in the uterus or visceral rupture. Although
infrequent, the presence of hemorrhage in both the thoracic and
abdominal cavities in association with parturition is most consistent
with a diaphragmatic hernia.
If the foal is not in danger of traumatic injury, it is best for the mare not
to remove the foal. Anxiety from separation of the foal, rectals,
twitching, etc. may increase blood pressure and decrease clot
formation. These mares should receive flunixin meglumine and additive
analgesics as required. The author’s preference is flunixin plus
butorphanol due to minimal cardiovascular compromise. In mares with
mild clinical signs, stall rest and symptomatic care may be the limits of
treatment. In mares with obvious hemorrhagic shock, hypertonic saline
may be administered followed by crystalloids. The antifibrinolytic
aminocaproic acid may be added to the fluids.
Although hypertonic saline is indicated for mares with hypotensive
shock it should not be used in mares that are stable, since a rapid
increase in blood pressure may displace an already formed clot.
Hetastarch is currently contraindicated as being potentially fibrin olytic
with dilution of clotting proteins. Whole blood can be provided from a
suitable donor horse or as an autotransfusion. Corticosteroids are
indicated to stabilize endothelial membranes, and naloxone may
neutralize vasodilatory endorphins.
Blood is not plasma
Failure of passive transfer of maternal immunity is a common problem
in stud practice. A foal requires 1–2 L of colostrum in the first 4 hours of
15-‐18
February
2016
East
London
Convention
Centre,
East
London,
South
Africa
73