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White milk at only 9 months gestation?

Once the mare is in foal the question period should be over, right? Wrong! It's only just beginning! Discuss ideas and tips here for management techniques for the pregnant mare, and the new born foal and it's mother.

Moderator: Jos

White milk at only 9 months gestation?

Postby CHCrystal » Tue Mar 18, 2014 10:29 pm

Hello,
I have an older (20) multiparous broodmare at 268 days. She has a small bag, but I am most concerned that her milk is white. Not just cloudy, but opaque. At 240 days she had the small bag, with cloudy milk, but showed no other signs of impending parturition. Now her tail and vulva are more relaxed. Her croup is still round and tight. Should I be worried?

She lost a foal at 208 days in 2011, had a healthy colt in 2013. Even unbred she tends to develop a small bag with clearish or amber liquid in the spring while she's out on the new grass. Could this just be the pregnant manifestation? None of her previous pregnancies produced this result. She's always progressed through the normal stages of amber, to cloudy, to white about 24-48hrs prior to foaling. She's been a fairly text-book mare. Her fillies, even due in April have been as early as 238 days. Her colt last year was 342. She was not bred on foal heat.

-Crystal
CHCrystal
Nursing Foal
 
Posts: 12
Joined: Sun Apr 28, 2013 5:34 pm

Re: White milk at only 9 months gestation?

Postby Jos » Wed Mar 19, 2014 10:02 am

Get your vet out!

At that point, it's considered "inappropriate lactation" and is quite likely an indication that she is attempting to abort. You need to have your vet confirm that she is still pregnant with a live foal on board, and then initiate anti-abortion therapies. Additionally, they should ultrasound the mare to determine what the CTUP (combined thickness uterus and placenta) measurement is, which may indicate or rule out placentitis.

Good luck!
We're always happy to try and help, but don't forget to check the articles section
of the website too, which has a search engine to help you look for answers!
:)
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Jos
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Re: White milk at only 9 months gestation?

Postby CHCrystal » Wed Mar 19, 2014 9:54 pm

Thank you Jos! Your advice gave me the confidence to insist when the new vet wanted to send us home to wait it out. We waited for our normal vet and got the ultrasound. Placenta ranged in thickness between 5 and 16cm, he said of more concern were a couple spots where fluid was between the layers of the placenta and that we probably caught a very early placentitis and have a great chance of treating it successfully. Very big, active baby bouncing around during the ultrasound :).

-Crystal
CHCrystal
Nursing Foal
 
Posts: 12
Joined: Sun Apr 28, 2013 5:34 pm

Re: White milk at only 9 months gestation?

Postby Jos » Wed Mar 19, 2014 10:45 pm

Glad to hear that a definitive diagnosis was obtained. Hope that Regumate, Flunixin Meglumine ("Banamine") and antibiotics have been started. Also worthy of consideration is pentoxifylline and estrogens.

Fingers crossed for you and your foal! :)
We're always happy to try and help, but don't forget to check the articles section
of the website too, which has a search engine to help you look for answers!
:)
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Jos
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Re: White milk at only 9 months gestation?

Postby CHCrystal » Thu Mar 20, 2014 9:50 pm

She has been started on sulfa antibiotics twice a day and we're ordering the pentoxifylline. I was told Regumate would not be necessary, but I do have have it on hand. He didn't seem familiar with using it for this situation, just asked if her progesterone levels had ever been tested and that they don't usually supplement after 120 days. I've read your article on Regumate and haven't really used it since, but some clients insist. If her cervix is holding tight, do we still need to put her on the regumate? They didn't give me banamine either. Her main red-flag was the white milk and even that he said was fine for her gestation. I've never seen that in a healthy pregnancy. They admitted most times the mares don't come to them until it's too late.

Sidebar... should I be worried about her having enough colostrum by the time baby arrives? Is it safe to freeze colostrum from another of our mares, or would that be taking too much from the donor mare's baby? I have one due in the next 2-4 wks that has always been an outstanding milk producer with very healthy, robust babies.

-Crystal
CHCrystal
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Posts: 12
Joined: Sun Apr 28, 2013 5:34 pm

Re: White milk at only 9 months gestation?

Postby Jos » Thu Mar 20, 2014 11:04 pm

As you will have gathered from the article on our website, I do not encourage the use of Regumate lightly. It does however have its uses, and the treatment of placentitis is one. If you are not comfortable with the level of treatment you are receiving from your attending veterinarian, you might consider trying to encourage them to contact a veterinary teaching hospital for some suggestions, or even taking the mare there.

Re: Colostrum - it is always worth while having some stored fro a good producing mare. The only caveat is to ensure that the mare is not one with an issue related to neonatal isoerythrolysis (if she has had foals, but hasn't had an NI baby, then you will probably be OK).

With respect to the use of Regumate, the following is taken from "LeBlanc MM, McPherson M, Sheerin P. (2004) Ascending Placentitis: What We Know About Pathophysiology, Diagnosis, and Treatment." in the Proceedings of the 50th AAEP Convention. the full paper should be available to your veterinarian through IVIS.org (there's a link in the left margin of this page), or through the AAEP. I hope it helps.

Treatment with progestins has long been advocated to promote uterine quiescence in pregnant mares withuterine
pathology. The actual rationale for progestin use in late pregnancy is not clear. Presumably, the anti-prostaglandin effect of
progestins contribute to reduced myometrial activity by interfering with up-regulation of prostaglandin and oxytocin
receptors [56]. Without receptor formation, gap junction formation is inhibited and uterine contractility prevented. Daels et
al [35] tested the effects of progesterone and altrenogest, a synthetic progestin, on pregnancy maintenance in mares treated
with the prostaglandin analog, cloprostenol. Sixteen mares with pregnancies ranging from 93 to 153 dGawere evaluated.
Cloprostenol (250 µg, IM) was administered to all mares for 5 consecutive days. Progesterone (300 mg, q 24 h, IM) was
administered to eight mares beginning 18 h after cloprostenol treatment and discontinued 18 h after the last cloprostenol
treatment. Altrenogest (44 mg, q 24 h) was administered to eight mares, orally, beginning 12 h after cloprostenol and
discontinuing 12 h after the last cloprostenol treatment. Five of eight mares in the progesterone-treated group maintained
pregnancies after cloprostenol treatment, whereas three mares aborted during treatment. All eight mares treated with
altrenogest-maintained pregnancies. All control mares (six mares from 82 to 102 dGa) aborted after cloprostenol treatment.
Administration of exogenous progestins to mares treated with cloprostenol was associated with a decrease in concentration
of endogenous prostaglandin metabolites. Results showed that progestin supplementation prevented prostaglandin-induced
abortion in most cases. Findings support the use ofprogestin supplementation in mares at risk for pre-term labor.
Progestin supplementation is currently being implemented in humans to halt pre-term labor. A recent double-blind,
placebo-controlled study [36] showed a beneficial effect when women with a documented history of spontaneous pre-term
delivery were treated with progesterone. The incidence of recurring spontaneous pre-term delivery was lower in women
treated with 17α-hydroxyprogesterone than in untreated women (36.3% versus 54.9%, respectively). In addition, babies
from progesterone-treated women required less oxygen therapy and had fewer cases of necrotizing enterocolitis and
intraventricular hemorrhage than babies delivered from untreated mothers. Whether progesterone plays arole in inhibiting
formation of gap junctions that facilitate myometrial contractions or interferes with prostaglandin-induced myometrial
contractions stimulated by pro-inflammatory cytokines is unknown. Effective treatments for placentitisin mares are still
elusive. Data from studies involving humans and non-human primates indicate that combined therapies with antibiotics,
anti-inflammatory agents, and progestin therapy show the most promise for interrupting pre-term labor. Preliminary data in
horses support this concept.
We're always happy to try and help, but don't forget to check the articles section
of the website too, which has a search engine to help you look for answers!
:)
User avatar
Jos
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Re: White milk at only 9 months gestation?

Postby CHCrystal » Tue Apr 01, 2014 9:51 pm

Thank you for the great information and assistance! Mare has regressed some, tightened back up. Her bag isn't growing, may have gone down a bit, it's pretty much a flabby bag, still has milk in it, but no more and possibly less than when we started. Looks like baby is growing at about the normal rate. She is now at 282 days. Next ultrasound is scheduled for 4/19 at 300 days to see how things look.

At what point in her gestation should I discontinue the regumate?

I've attended "red-bag" foalings before with successful outcomes, is there anything else I should be preparing for? What antibiotics or treatments are typical for a septic foal? How likely is it we caught it in time to avoid that outcome?

Thanks again,

-Crystal
CHCrystal
Nursing Foal
 
Posts: 12
Joined: Sun Apr 28, 2013 5:34 pm

Re: White milk at only 9 months gestation?

Postby Jos » Wed Apr 02, 2014 10:26 pm

CHCrystal wrote:At what point in her gestation should I discontinue the regumate?


We typically stop Regumate somewhere between 300-310 days.

I've attended "red-bag" foalings before with successful outcomes, is there anything else I should be preparing for? What antibiotics or treatments are typical for a septic foal? How likely is it we caught it in time to avoid that outcome?


If you have access to a welding kit, oxygen is useful to have on hand - but be careful with it, as it can cause explosions!

Discuss with your veterinarian the most suitable antibiotic for your situation, but Ceftiofur sodium is often used in this type of a situation.

As for the last question - I don't play the "what if" and "what's the chances" games... :D There's no point - it will be what it will be...! :D
We're always happy to try and help, but don't forget to check the articles section
of the website too, which has a search engine to help you look for answers!
:)
User avatar
Jos
Senior Stallion or Mare
 
Posts: 3948
Joined: Sun Jun 10, 2012 12:11 am

Re: White milk at only 9 months gestation?

Postby CHCrystal » Thu Apr 03, 2014 1:24 pm

Thank you! Fingers and toes are crossed! :<

-Crystal
CHCrystal
Nursing Foal
 
Posts: 12
Joined: Sun Apr 28, 2013 5:34 pm

Re: White milk at only 9 months gestation?

Postby CHCrystal » Sat Apr 19, 2014 11:26 am

Well... upside is we're at 300 days and still holding. Palpated a couple days ago and baby was moving. Mare is growing in size at a good rate.

Downside is... left side of her udder is now swollen, hot, painful. It had some red-tinged crust on the tip, so I removed that and expressed a couple drops of brownish red liquid. Pounding my head against the desk at this point. How does a mare that has been on Sulfa meds develop mastitis? Is that what ALL of this has been all along? If so, shouldn't the antibiotics have cleared it up? :?
There has never been any obvious odor, but I did notice free floating debris in the "milk" liquid, which I did mention to the vet, but with the placental thickening, wouldn't the treatment be basically the same for both conditions anyhow?

Waiting on the vet to call me back.

-Crystal
CHCrystal
Nursing Foal
 
Posts: 12
Joined: Sun Apr 28, 2013 5:34 pm

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