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Mare with cervix and fluid issues

Discuss all kinds of problems encountered in breeding mares from not standing for live cover, through to not getting pregnant for unknown reasons!

Moderator: Jos

Mare with cervix and fluid issues

Postby Cindy » Sun May 25, 2014 12:23 am

Sorry for the long story but I have some questions about a mare so I am going to start at the beginning. Mare is now 14yrs old, has had 4 foals (2 naturally and 2 by ET). I bought her last spring and spent a lot of money on have a repro exam done prior to buying her. I had a culture done on her and it was clean as well as a biopsy and she came back as Kenney category I. So I was super happy and purchased the mare thinking we had lots of babies in our future!

Fast forward to breeding season last year and I went to breed her. Cycle "appeared" normal, ovulated well, no fluid noted and we bred her with one dose of frozen. 14 days later we preg checked her and not in foal though she does now have a small amount of fluid. We planned on trying again on the next cycle so continued to track her. She grew a very large 60mm follicle but had a retainted CL present and would not ovulate it. So we gave her a shot of chorulon around day 22 post ovulation to see if we could kick off the follicle. Well she did by the next day but then the next day she also ballooned up with a HUGE amount of fluid which has been an ongoing problem since. I would love to hear any speculation of why all this fluid started in a mare that was previously just fine and healthy.

From there I took the mare to the best repro vet in our area, not a therio, but all they do is repro work so I figured they were much better than the local one anyhow. I spent over $4k there on her and they had no luck getting rid of the fluid. If they did it just came right back the next cycle. However, they told me her cervix was fine (which I disagree with as the fluid would come out if it was fine with oxytocin one would think) and that she just kept producing so much fluid. We cultured as well as tested for yeast. The yeast came back neg though I know she cultured dirty so they did flush her for a number of days. However, the next day she was always filled right back up with fluid. After 2 cycles there I brought her home again. As a last ditch effort we tried the MIsoprostol at home here and were happy to see the next day (with the help of multiple oxytocin shots which were previously unable to get the fluid out) that the majority of the fluid was gone! This was the end of Aug last year so since it was so late we just left her.

Fast forward to this year, I just had her looked at again this spring. She is again just absolutely FULL of fluid. My current vet does not feel I should even bother with trying to breed her and half of me agrees the other half knows how much I spent on this mare as a broodmare and can't help but think I need to try all my options. This vet did a culture (yes no cytology which I did not realise until after so we will have to repeat it). She cultured positive for pseudonomas (?) but since not cytology not sure how accurate that would be. My vet feels if we do try to breed her this year we should probably start with a biopsy. After all the fluid in her uterus for almost a year now I am afraid her poor uterus has probably paid the price. But lets say best case scenario maybe she is now a IIA biopsy score and I did chose to tackle breeding this mare, where would I start and do you feel like there is any hope of getting her in foal?

I was thinking I would start with the biopsy and another culture. If dirty she would then be flushed and cleaned. Current vet says that inside her cervix she has a bit of a ledge that she has to go up and over and we believe that is what is causing her not to be able to expel the fluid she accumulates in her uterus. So I am assuming that she would need to use the Misoprostol for flushing her as well as well as lots of oxytocin. If she is dirty should we plan on flushing her for one cycle and try breeding on the next. How long does the Misoprostol last, how often can I use and how close to and long after breeding can I use it?

I am really unsure of why all this fluid started in the first place and it truly baffles me but it is really a large amount. Any thoughts or suggestions on how or if I should proceed? I am told with a speculum her cervix looks fine but it has a bit of a ledge in the inside (scarring??) that is not allowing the fluid to come out.
Cindy
Weanling
 
Posts: 26
Joined: Sun Jun 24, 2012 12:50 pm

Re: Mare with cervix and fluid issues

Postby Jos » Sun May 25, 2014 6:43 pm

Pseudomonas aeruginosa is one of the few organisms that should always be treated, so going back and performing a cytology smear is probably academic (although yes one should have been done! :) ).

What you might want to contemplate doing is either treating the mare and then having the biopsy and culture performed, or doing the same thing the other way around. I think my preference would be the former - that way you will get an idea if you have cleared the Pseudomonas. Note that the biopsy sample itself can be cultured - a separate swab is unnecessary. Alternatively, a low-volume lavage can be cultured, which provides a more accurate diagnosis than a swab culture.
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
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Re: Mare with cervix and fluid issues

Postby Cindy » Sun May 25, 2014 9:02 pm

Thanks so much Jos, we will go ahead and treat first and then do the culture biopsy to see if it has cleared. How hard it Pseudomonas aeruginosa to clear? My vet was talking about flushing with appropriate antibiotic for 5 days. Just wondering if it was a persistent infection and really tough to treat.

Also how often can I use the Misoprostol? As often as needed or does there come a point it is detrimental to the mare?

I will keep you posted on how things look after treating and the biopsy results. Just curious though, if we treat during the next heat cycle, what do I do the following one? I am not sure we would get the biopsy back quick enough to breed on it or not. Yet if she is going to balloon up with fluid again for the next cycle after the treated one, I am presuming I don't just want to leave it in there do I? Would you use Misoprostol and oxytocin for that cycle to just keep the fluid out or once she is clean and treated the fluid should be harmless?? Just not sure how to go about the fluid issue. Thanks!
Cindy
Weanling
 
Posts: 26
Joined: Sun Jun 24, 2012 12:50 pm

Re: Mare with cervix and fluid issues

Postby Jos » Sun May 25, 2014 10:24 pm

Cindy wrote:How hard it Pseudomonas aeruginosa to clear? My vet was talking about flushing with appropriate antibiotic for 5 days. Just wondering if it was a persistent infection and really tough to treat.


:( :cry: Are you sitting down...? Pseudomonas is a miserable S.O.B. to treat... It's a potent biofilm producer so Dr. LeBlanc recommends (Leblanc MM. (2008) When to refer an infertile mare to a theriogenologist. Theriogenology 70(3):421-9):

"If an organism is a known biofilm producer, we recommend irrigating the uterus with a DMSO/saline solution (50–100 mL of DMSO/L saline) for 2–3 days in an attempt to remove the biofilm. Intrauterine antibiotic treatment is then started on the third or fourth day of uterine irrigation. Intrauterine antibiotics should be infused daily for 4–5 days."

Acetylcysteine can also be used and is slightly newer, so not reported in the above work, but LeBlanc later comments in another publication ("Chronic infectious endometritis: what’s new, what’s old, what works"):

DMSO (10-30% solution-100 to 300 ml/1 L saline) is most commonly added to lavage fluids although it has been infused into the lumen as a post breeding treatment (30 to 40 ml in 150 ml saline). When used as in lavage fluids, 1 L is infused into the uterus and then immediately recovered. Acetylcysteine solution (30 ml in 100 ml saline) is infused into the uterus and left overnight. The uterus is flushed the following two to three days with either saline or lactated ringers. The efflux is examined for exudate, strains of mucus and particulate matter. It is not uncommon for lavage fluids collected on days 2 and 3 to contain thick mucoid strains.

The fluid presence may well be related to the Pseudomonas.

Also how often can I use the Misoprostol? As often as needed or does there come a point it is detrimental to the mare?


Within reason. Digital dilation during estrus can also be valuable, and one can also use Buscopan topically.

I will keep you posted on how things look after treating and the biopsy results. Just curious though, if we treat during the next heat cycle, what do I do the following one? I am not sure we would get the biopsy back quick enough to breed on it or not. Yet if she is going to balloon up with fluid again for the next cycle after the treated one, I am presuming I don't just want to leave it in there do I? Would you use Misoprostol and oxytocin for that cycle to just keep the fluid out or once she is clean and treated the fluid should be harmless?? Just not sure how to go about the fluid issue. Thanks!


If the fluid is related to the Pseudomonas and you manage to clear the pathogen, then you'll see a healthier uterine condition the net cycle. If not, then you will want to try and keep fluid to a low murmur with uterine lavage and a prolonged oxytocin protocol. We will put these types of mares onto oxytocin 4x daily from the first day of estrus through to 3½ days after ovulation. You may also wish to consider purchase (through your vet) of the biorelease oxytocin from BET Pharm which can be given twice daily - and is nice for night time use rather than having to go out at midnight and again at 6 am!

Good luck and keep us posted!!
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: Mare with cervix and fluid issues

Postby Cindy » Sun May 25, 2014 11:08 pm

Hmmm...sounds like we have our work cut out for us for sure! Does not sound like a cheap endeaver either, got to love breeding sometimes, lol.Thanks for the input, I really appreciate it Jos.
Cindy
Weanling
 
Posts: 26
Joined: Sun Jun 24, 2012 12:50 pm


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