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Recto-vaginal fistula

Equine-Reproduction.com Bulletin Board » Breeding Problem Mares - Volume 1 » Recto-vaginal fistula « Previous Next »


Author Message
 

karen
Posted on Monday, November 06, 2000 - 08:50 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Hi! We have a mare that sustained a rectovaginal fistula this spring when she foaled - although the baby's feet were safely out the vulva, his nose came through the rectum. As soon as we realized what was happening, we redirected the nose, and the delivery proceeded normally. So the mare had a "nose-sized" hole into the rectum about 4 to 6 inches from the entrance. The injury did not cause a total 3rd degree laceration through the perineum.

This injury was surgically repaired a few days ago at Ohio State University, and they gave the mare a good prognosis. My question concerns rebreeding her. This had been her first foal - she is a very large TB mare used in a warmblood breeding program. All breeding is by AI. I have been assured by my vets that it is unlikely that this mare would ever have this problem again, but I am still of course anxious about it. I had never seen a rectovaginal fistula before, or I might have recognized what was happening quickly enough to prevent the injury entirely (hind sight is 20/20, I guess). So, is there anything I can do with this mare (or any mare, for that matter) to prevent this problem again, or to recognize that it's happening quickly enough to prevent an injury to begin with? Thanks in advance for your input!
 

Jos
Posted on Tuesday, November 07, 2000 - 08:24 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Recto-vaginal fistulas are more common with first foals. What happens is that a portion of the foal gets caught on it's passage through the vagina, usually on such a protuberance as the remnants of the hymen membrane. The foot then gets forced upwards during the mare's foaling contractions, and punches a hole in the tissue between the vagina and the rectum. Sometimes the mare stops "pushing" at that point, and the weight of the foal carries it back down into the uterus a bit, which withdraws the foot from the rectum, and if you're lucky the next contractions will occur when the foot is pointed in the right direction for exit through the vagina. In actual fact, that is probably what happened with your foal, but then the nose managed to find the same hole in the vagina/rectum. I'm glad you were present at the foaling - an occurrence such as this is always added fuel for the argument that there should always be someone present at a foaling!

In answer to your question - no, there isn't really anything that you can do that I am aware of, except of course be there again. As the vagina is now stretched as a result of having had a foal pass through it and as many of the little protuberances such as the hymen will have been smoothed out by that passage, your vets are absolutely spot-on when they say that the likelihood of it's re-ocurrence is slim. The only thing you may want to do once the surgery site has had time to heal is to check that there is no scar tissue which protudes unduly into the vagina - the chances are that it won't though as it's a highly vascular region that usually heals well.

Good luck!
 

karen
Posted on Wednesday, November 08, 2000 - 04:53 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Thank you for you input! The mare is doing well, although she's still a bit sore. She had a "different" approach to the repair; because her rectal sphincter wasn't damaged during the foaling, they didn't want to have to go through it to repair the defect. So they bisected the perineal body down to the level of the injury and repaired the vaginal hole from above and the rectal hole from below. It was actually fascinating, and I sure hope it works! It's been almost a week now sinse the surgery, and all seems well.

So, back to the question about preventing this sort of injury in the first place. I don't like to interfer with foaling, although I do check (wearing a sterile OB sleeve) the foal's position when the mare breaks water. If all is well, I stay in the stall, but don't get "aggressive". With this mare, sinse it was obvious that the foal was very large, I checked the position a couple of times between the mare's contractions, and all seemed well. I had about 10 seconds to realize something was wrong - I actually thought the mare was prolapsing her rectum, then the nose came through. Of course then I knew what was happening and pushed the nose back (reading about bad things you've never seen pays off!) and redirected it out the vulva.

So, how aggressive should one get when overseeing a foaling? Is it reasonable to think that I could have prevented this injury (or that I could prevent future ones), or is that unrealistic? Should one have one's hand in the vagina the whole time to ensure that all of the foal's appendages are heading in the right direction? I know each situation is indivudual, and I do everything in my ability to attend all foalings, but I wonder if I should have been more "hands-on." At the same time, I don't want to interfer more than is necessary.

So it's a dilemma - and I suppose there's probably no right answer. Oh, well, thanks for any input you might have anyway!
 

Jos
Posted on Thursday, November 09, 2000 - 09:06 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

While I can understand your current dilemma, it is normal protocol not to interfere in the birthing process at all, but merely to observe. If all is progressing smoothly one need not even be in the stall with the mare. Equine births are not an assisted process in the same way that human births are.

If there appears to be a problem, then (of course depending upon what the problem is) it is only if no other recourse is available that one should glove up and enter the mare. A more normal course is to get the mare to stand and possibly walk, and await the arrival of the vet. This does of course as I say depend entirely upon the circumstances. In a situation such as you faced, it goes without saying that immediate intervention is necessary. Likewise in a so-called "red-bag" delivery. In those cases seconds count. In a minor malpresentation where a simple repositioning or light traction on the foal does not resolve the problem, unless one is highly experienced it is usually best to attempt to distract the mare and await the vet.

With your situation for future foalings, I would feel more inclined to be prepared to intervene, but would not necessarily do so as a matter of course. You could find that you upset the mare by doing so.

As ever, it would be good for you to discuss this with your veterinarian who is aware of any limitations placed upon your mare as a result of this surgery.

Good luck!
 

karen
Posted on Thursday, November 09, 2000 - 10:09 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Thanks for your reassurance! I have attended many foalings, and also have a fair bit of experience in human medicine (where yes, we are VERY involved in the delivery of babies), but I have always felt that "non-intervention" was the best policy with equine deliveries. Other than checking the foal's position (as I was taught years ago at a very large breeding farm), I "keep out" and just observe. If I think there's a problem, I assess the situation and call the vet if needed. So it's reassuring to know that I don't need to get more aggressive as a matter of routine!

My vets feel very optimistic about this mare's ability to heal well and continue her life as a broodmare. I think I was just spooked by the whole calamity, and questioned if I should intervene more than is my habit. I'm glad to hear that non-intervention is still the best policy in the normal delivery. Thanks again for you input.
 

Karen
Posted on Thursday, November 09, 2000 - 05:20 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I have an unusual question, but one I would like to get some "expert" advice with. My friend recently bought a new pony filly(2 year old) for her son, who's been riding her for two months now, and now it turns out the filly is pregnant. She is probably 7-8 months along, and the pony is 14 hands and the probable sire is 16 hands. They are talking about aborting the pony. Is it better to let it go and let nature take it's course, or is it better to do the abortion, even at this late date? What is the bigger risk?
 

Jos
Posted on Thursday, November 09, 2000 - 09:05 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I believe I have already been conversing with your friend privately! I will reproduce the relevant potions of my response here:

It is unlikely that it will be a problem, although of course it is not a really desirable situation. You should probably consult with your veterinarian though, who will be able to give a complete evaluation of the situation.

In Europe it is common for young mares 2 or 3 years old to be bred, but those are warmblood mares who are bigger. Generally though, the limiting feature with regards to foal growth is the mare's uterus size, so it's not often that a foal is produced that is truly "too large".

What can happen is that a portion of the foal may be awkward in size - typically the shoulders, and the mare may need some assistance while trying to birth that portion.

If she is only 3-5 months pregnant, then you can still try to abort, but you should talk to your veterinarian about that too. You can try multiple doses of PGF2a, or there are surgical methods. As I say, a veterinary domain.

If you decide to let her go to term, then you should make sure that you are present at the foaling, as she may need assistance.

On the whole though, there's probably not to much to worry about.

If you elect to go for termination of the pregnancy, reduction of any pregnancy post-day 35 is hampered by the actions of the endometrial cups in that they encourage the growth of secondary CL's which secrete progesterone, which is a major hormone in connection with pregnancy maintenance at that stage. Any treatment to hormonally reduce the pregnancy will revolve around removing the sources of progesterone - i.e. the CL's, and this is usually achieved by multiple doses of Prostaglandin F2 alpha. It should be noted that a single dose is unlikely to achieve the effect, and usually multiple doses daily over the course of several days are required and even then it is not always successful.

Digital manipulation and expansion of the cervix, followed by saline lavage of the uterus can also be used, but is probably more traumatic than the PGF2a.

Abortion can occur naturally at any stage of pregnancy, so I guess there's no real "too far".... the thing to be concerned about is the possibility of complications due to fetal size, and at this stage, you're only looking at a couple of inches, so it's not really a problem yet.

If it were me, I would still want to have the ultrasound performed to make sure the mare was indeed pregnant and also to obtain a "base line" so that when treatment is commenced one has something to measure effect against.
 

Anonymous
Posted on Saturday, February 10, 2001 - 10:24 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I HAVE A YOUNG MARE THAT I BRED IN 2000 FOR THE FIRST TIME AS A 2 YEAR OLD. SHE SETTLED 3 DIFFERENT TIMES, AND ABORTED 3 DIFFERENT TIMES, ALL BEFORE 65 DAYS OF PREGNANCY. HER TONE WAS NOT GOOD AT TIME OF CONFIRMING FIRST PREGNANCY, THE TONE WAS VERY GOOD FOR THE SECOND, AND SHE ALSO FELT FINE AFTER LOSING THE 3RD PREGNANCY BUT WAS DEFINITELY OPEN AT THE TIME OF PALPATION. WHAT CAN I DO THIS YEAR TO ENCOURAGE HER TO STAY PREGNANT? CONCEPTION DOES NOT APPEAR TO BE A PROBLEM BUT MAINTENANCE OF THE PREGNANCY CERTAINLY IS.

THANK-YOU FOR ANY POINTERS YOU CAN SUGGEST.
 

Jos
Posted on Sunday, February 11, 2001 - 04:35 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

There are two considerations that come to my mind right away.

Firstly, some fillies are not ready to be pregnant at 2, so it may be that it was merely natures way of saying "no".

Secondly, did you have a uterine swab sample taken with a culture and cytology sample prepared and read (cytology is very important - without it the culture results are meaningless). Despite the fact that she is a filly and maiden, she may still have a uterine infection of some sort.

Get a complete breeding soundness examination performed by your vet. - it's a really good place to start with a filly such as this.

Good luck!
 

Anonymous (209.112.95.89)
Posted on Tuesday, June 12, 2001 - 05:30 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I have a friend who's mare has been at a training center for 5 weeks. It seems last weekend, while the owners of the center were away, an aggressive stallion, also there for training, got out of his stall during the night. It appears that he went visiting my friends' mare and her door was kicked out. In the morning when the helper arrived to do turnouts she found the two running together in the barn. The owners of the center have tried to keep things hushed and didn't come clean about what took place. Through putting the pieces together the story is unfolding. Since we have not been involved in breeding before some questions have come up. First, is it common for the mare to have cuts on her inside thighs from the stallions' front shoes? Her rear legs are also swollen and obviously causing her discomfort. Is this common from breeding or possibly this is from her kicking the door? I understand that the owners don't want this information to be spread around. On the other hand my friend was not even phoned to be advised to check on her mare. It's a sticky situation. Any thoughts or advice?? Thanks
 

Kelly (63.172.47.189)
Posted on Tuesday, June 12, 2001 - 10:19 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

This is more than a sticky situation.

The owners should have been the first ones called. These things can happen, but to allow this mare to possibly be bred and not inform the owners is a lawsuit waiting to happen.

My first concern is that a pregnancy will be acceptable. If not, they had better make some decisions quickly. They will need to give this mare a shot of Lutelyse to insure that a pregnancy does not indure. Any and all madical attention given to this mare should be done with the owners consent.

ALL bills incurred from this situation will be the responsibility of the barn owner. If the trainer leases the barn, then ALL of the bills associated with veterinary care, stallion fees ( if pregnant and desirous of papers), Feed and board for the mare and foal untill the time of weaning, vaccinations, worming....you get the picture.

The injuries could have happened in different ways. She could have kicked the door, been caught on or in between the door, running around all night on hard ground, fighting off the stallion,( if she were not in heat ). In a responsible breeding situation, all concerned are protected from injury.

It is very irresponsible of the people in charge to attempt to keep this occurance a secret. It makes me wonder if they have administered Lutelyse themselves. Even if they do not think that this mare was in heat, a vet check would be in order. They are lucky that nothing more serious happened to either horse or any others in the barn.
 

Anonymous (209.112.93.44)
Posted on Tuesday, June 12, 2001 - 08:23 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Kelly, thank you for your response. My friend has been discouraged (by the owners) on having her mare checked by the vet. I think you are probably accurate wondering if they have administered the Lutelyse. We hadn't even thought of that possibility. Yesterday when the owner gave a "little" info to her he was very sure that a pregnancy will not result. If this was done, it was without her approval. Is there any way the vet can determine if her mare did receive it? This is a large, known training center & I am CERTAIN they do not want this to get out. Thanks a ton for your help!
 

Kelly (63.172.47.215)
Posted on Tuesday, June 12, 2001 - 10:54 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

The owners should PAY for the vet work. There is no way that the owners could be sure that this mare did not get bred. There is no way to tell if this mare has conceived yet. They could tell if she had recently ovulated, by way of ultra sound. This should be done immediately. Does anyone know when she was last in heat?

Typically, the mare will cycle 3 to 5 days after the shot. If she were indeed in heat last weekend, a first shot would be given at about 5 days . A second shot may need to be given again at the 5 day mark. Within 5 days, she should then cycle.

They probably don't want the vet to know anything, because...well, people talk.

Some mares can react to the shot with excessive sweating, cramping and colic like symptoms. It will last for only a few minutes, to an hour or so. The best case senario is for the horse owners to request the shots, have a VET give them ( for legal purposes ) and insist that the barn owners pay for EVERYTHING. I feel sorry for your friends, they are not being treated in an honest or professional manner.
 

kelly (63.172.47.212)
Posted on Monday, June 18, 2001 - 04:48 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Anonymous from June 12- What did your friends decide to do? Did the mare get checked? I hope that all went well.
 

Anonymous (209.112.94.161)
Posted on Thursday, June 28, 2001 - 03:54 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Well, the barn owners seemed over confident that the mare was not in heat when the incident took place. Five days later she was in heat so my friend did not have her checked. The husband talked in length with my friend & then separately with me because bits of stories started circulating around the barn. I was confrontive with him about the way they handled the whole situation & he admitted he handled it poorly. He said he learned from it & he is trying to make it up to my friend. She was very easygoing about the whole matter. They could have had a nightmare with someone else who wasn't so tolerable.
I spoke with a woman who has been at this barn for 9 months & she also felt it was handled poorly. She felt certain that the owners would not have given the mare Lutelyse, although during all this mess they did medicate this woman's gelding without her permission!
At this point the mare is well. Her cuts & scrapes have healed & the swelling has subsided. We will be moving from there soon.
What actually happened that night will remain a mystery known only to the mare, the stallion & those who looked on from their stalls! Any human deceit that may have taken place will carry it's own consequences.
Thank you Kelly for your knowledge & help. KB
 

Kelly (63.172.47.187)
Posted on Thursday, June 28, 2001 - 06:30 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

K.B.- I am glad that it worked out alright. Without your input, things may have turned out differently. Congratulations for not backing down or keeping their "secret". Because of your actions, that mare is being taken care of, and the owners have learned something about honesty.
 

Pamela Edwards (216.234.127.72)
Posted on Friday, March 08, 2002 - 10:48 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I am considering buying a broodmare (reg. Tennessee Walker) who is 14 years old and is in foal with her 10th pregnancy. She is not worked at all and is only used for breeding and turned out to good pasture. She has delivered and raised 9 healthy foals and always gotten pregnant on the 1st breeding during foal heat. She appears healthy. I am going to Kentucky to buy a couple of broodmares to breed to my black tobiano walker stallion. Here's my question: How many is too many? Does a mares uterus get all stretched out after this many pregnancies and does that make a usually uncomplicated delivery more risky. Do they just wear out?! Is it OK for a mare to foal every year for 20 years, or is there a point that it becomes just too much and she should no longer be used. I don't want to buy one that may be about tapped out and need an answer right away. To the best of my knowledge this mare has not experienced any foaling problems to date. Thanks for a quick response.



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