Last spring, our Dutch WB mare had a difficult delivery and needed help for an easily corrected shoulder dystocia. As well, there was a partial red bag that presented with the foal's nose. It wasn't a full red bag as the membranes stayed inside the mare as we delivered the foal and then the whole thing slipped out some 30 minutes post delivery, checked by vet to be all in one piece. As a precaution, he gave a dose of oxytocin and started her on SMZ.
2 days after the delivery, the mare had dark blood coming from her vulva when she lay down to rest. The weird thing was this mare was active, bright and eager for food. We shipped her to the vet for a checkup and lavage. There was a lot of blood, but it was old dark blood. Vet drew blood to check her Hg counts which were all normal. Vet checked her cervix (good) and vagina (tiny laceration, vet adamant not the cause of bleeding).
My question was - where did it come from?
When the partial red bag occurred, could this have caused a nick in a blood vessel in the uterus and the blood pooled in there until she lay down?
Or, worse case scenario, was there actually a minor rupture of the uterus.... although wouldn't this have caused the mare distress and wouldn't she have become profoundly shocky and sick???
We chose to leave the mare open for 2011, but now we are considering breeding her for 2012. The big question I have is... is her uterus safe for pregnancy or could it rupture when the foal starts to put on size? This mare tends to grow big babies.
This mare is very well-bred, usually awesomely fertile and her babies have always been premium awarded. I suppose we could ET, but it would rather be a last resort.
Obviously we will be getting a culture and biopsy done, but I'm concerned this won't necessarily show the real picture (risk for rupture). Thoughts and suggestions would really be appreciated. Thanks in advance!
It would not be unusual for a mare to have "old" blood leaking from the vulva 2 days postpartum. In fact, I would consider it to be normal. There is a tremendous insult to the uterus during the foaling process with the separation of the placenta - not to mention the stretching and straining associated with the foaling process itself - and consequently there is some blood loss during the process. This will typically not manifest as complete and immediate clearance, but will tend to leak out over the next few days while the uterus is involuting.
My guess is that what you saw was perfectly normal.
In the absence of obvious damage to the uterus - which your veterinarian has apparently ruled out - there would be no greater risk during future pregnancies than is normally present (and there is always some risk).
I guess I need to be clearer - -there was not just blood leaking or normal postpartum liquor...it was running from her and her tail was soaked top to bottom and dripping, which then got all over her flank from swishing it. The vet was also rather shocked at the sight of all this blood. Total of 12 L of sterile saline was lavaged and we collected close to 14 L of fluid plus clot which kept clogging up the lines of the catheter, so it was a LOT of blood and rather scary to see. The weird thing was, the mare was not shocky and quite bright and alert. So where would all this blood be coming from....
The chances are that there was either a tear as a result of stretching, or the foal caught something somewhere with it's foot on the way through.
It is important to consider that the uterus is a vascular organ and reparation is pretty effective. I suspect when you are referencing a "rupture" - either this time or in the future, what you are thinking of is a uterine artery rupture, but that is not going to typically manifest as bleeding into (or via) the uterus, but rather is a bleed into the broad ligament. When there is an instance of the broad ligament subsequently rupturing, that is when mares die owing to the rupture, but they typically "bleed out" internally, not externally.
Consequently, despite there being a different picture painted from the "old blood" previously mentioned, I would still not be significantly concerned in this instance. Yes, obviously perform a thorough pre-breeding evaluation prior to breeding again and base your final decision on that, but I would not rule out the possibility of rebreeding based solely upon what has apparently passed so far.
If your concerns continue or if further evaluations suggest they are valid, if the mare is worth it, then embryo transfer is always an option...
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