I have a TB mare who I have been trying to get in foal for three seasons now. She is a 9 year old maiden, and has conceived twice, but lost the pregnancy prior to 30 days both times. She cultures clean and has a IIA biopsy. I have tried two different stallions, both fresh chilled. This mare has a huge inflammatory response to being bred, and gets large amounts of fluid. She also has a tightish cervix, even when in heat. I have tried the oxytocin protocol, but did not get a pregnancy.
I am wondering if there is anything I can do to... 1) Relax her cervix post breeding so she can more efficiently clear fluid, and...2) Administer some kind of immunosupressant to minimize the inflammatory response. I have heard of "Dexamethasone". Could this possibly help? Also, could a DMSO lavage help this mare in any way? Or could it cause an even worse situation due to her sensitivity?
The last time this mare conceived, she was given post breeding lavage, and a caslicks. Nada at 30 days.
Presuming that all factors with the stallions and the timing of the inseminations are OK, it is quite likely that the causes of pregnancy failure revolve to a great extent around the non-relaxing cervix.
The cervix relaxed during estrus in response to riding levels of circulating estrogen (secreted by the follicle), so one way of assisting relaxation is by giving the mare exogenous estrogen. Another technique for encouraging relaxation is use of a topically-applied prostaglandin E cream, which can be made from misoprostol and a gel by your veterinarian or pharmacist. Digital manipulation of the cervix is also valuable for encouraging relaxation.
Dexamethasone at the time of breeding has been demonstrated to reduce fluid accumulation and increase pregnancy rates in susceptible mares (Bucca S, Carli A, Buckley T, et al. The use of dexamethasone administered to mares at breeding time in the modulation of persistent post breeding induced endometritis. Theriogenology 2008;70:1093–1100.).
DMSO has the ability to remove biofilm associated with some uterine pathogens, and also may have a postiive effect on reversal of fibrotic changes. We have seen some success with mares that have an indistinct problem (manifested by failure to establish or maintain pregnancy) with the use of a Betadine/DMSO lavage, followed the next day by a saline or LRS lavage. Note that these are lavages, not infusions, and therefore the Betadine/DMSO is drained out of rather than left in the uterus. Details are given elsewhere on this board about this protocol (you can do a search for "Betadine" and it should show up - the search link is at the top of the page).
Having said all of the above, I would probably start back with a basic evaluation with a uterine swab and review of the cytology. After multiple invasions of the uterus, it is not uncommon to find that if there wasn't something there before, there is now. Note that the cytology is the most important first step - more important than a culture at that stage, and a culture can be performed if there is a positive finding on the cytology (i.e. inflammatory cell presence).
If you are going to be sending it to the lab immediately, air-drying without a fixative will probably be OK, but you can find aerosol cans of slide fixative that a quick spray after air-drying may render a better sample for the lab. The one caveat there is that the fixative may prevent stain penetration, so maybe talk to the lab and see how they are staining it, and if the fixative is going to cause a problem for them.
If you are looking at cytology only (not culture), we like to use the swabbing brush that is available from Har-Vet - it looks like a McCulloch swab (double guarded) but instead of the cotton swab on the end it has a little brush which collects cytology samples very well.
If using a cotton swab, moisten it prior to smearing - you will get a better smear.
Collect sample using swab or brush;
Smear sample on clean microscope slide (moisten cotton swab prior to smearing if not using a brush);
Maybe spray fixative;
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