Late term abortion and the mare isn't cleaning

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weebiscuit

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When we went to the barn yesterday morning we found that one of our mares had foaled, 9 weeks early. Of course the foal was dead, but obviously the mare had cleaned it off or it broke the placenta during birth, because it didn't have any on it. Part of the placenta was hanging out of the mare. We figured that when we found her the foal couldn't have been more than two hours old, because it still had a bit of warmth to it. I gave her 1cc of oxytocin and waited two more hours and still still hadn't passed it so we called the vet.

He gave her another dose, plus penicillin, bute, and tetanus, and told me to give her an hourly 1CC of oxytocin for three hours, then wait three hours and do another dose, and then again in three hours and if she hadn't cleaned by this morning to bring her in to the vet hospital. This morning she still hadn't cleaned. Just the same glob hanging out of her as yesterday morning, so we brought her into the hospital at 8 AM.

The vet gave her another dose of oxytocin and tied a weight to the placenta. We waited there for two hours and she still hadn't expelled it. We had to leave at that point and the vet taking care of her said she'd call and let me know if it passed, but they would keep her there three days after passing in order to infuse her uterus with antibiotics for three days in a row.

We have never had a single problem with this mare. She's always been an easy foaler. But I noticed that when we found her early yesterday morning with the dead foal I checked her udder and there was no milk in it. I'm assuming it's because the foal was aborted and not full term? So, without a foal sucking, there wouldn't be the uterine contractions to help her expel it, but I can't understand why the oxytocin isn't working. She's had tons of it!

I am very worried about her. This is my absolutely most favorite mare, Reece's Hello Baby Doll, who we've always called "Mama" because she is the most amazing mother and also the Alpha mare in the herd. At this point I don't even care if she can't be bred again... I just don't want to lose her, and if we had to sell every horse on the place she is one of two horses we would keep forever, because they are so wrapped around our hearts.

Has anyone had this happen before, where the placenta just won't pass?
 
I've had placentas fail to pass for days before, I think 5 days is my personal record. There comes a point where they won't pass normally at all, but rather they decay out over a period of time. Smelly and foul.

The good news is that most of mine that were doing well and receiving Vet care, continue to do well. Its the group that shows up sick or foundered that will have trouble.

Her reproductive status may be at question. She almost certainly won't get pregnant this year, and I've had some never carry again.

Hope she does well for you.

Dr Taylor
 
Well, the vet could try flushing the uterous out. Usually we put a garden hose-sized tube in and run gallons of fluids through to try to wash it out. You absolutely should not pull it out; a vet will know just the right pressure to use to prevent tearing. Oxytocin and PGF2a will also help contract the organ, but won't always expel it if its attached strongly. Banamine to prevent toxic shock. Eventually it'll loosen and fall out, I hope. Best of luck, I'm sure your vet is taking good care of her
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I've had placentas fail to pass for days before, I think 5 days is my personal record. There comes a point where they won't pass normally at all, but rather they decay out over a period of time. Smelly and foul.

The good news is that most of mine that were doing well and receiving Vet care, continue to do well. Its the group that shows up sick or foundered that will have trouble.

Her reproductive status may be at question. She almost certainly won't get pregnant this year, and I've had some never carry again.

Dr Taylor
You know, this is the first late term abortion we've ever had, and it's the only foal we've ever lost, because we have video cameras in the barn and use halter alerts. I've had one red bag delivery, but because of the halter alarm I got to the barn in time to save the foal. Our hay ground used to be a corn field. We killed off everything in it, and then planted a Pasture Perfect mix for horses, certified to be fescue/endophyte free. Same with the horses' pastures. I'm sure infected fescue seed could have blown in from neighboring areas, but I know it's not my feed that caused this, so I'm just putting it down to one of those "flukes of nature" that sometimes happen.

The only other foal we lost was when we bought a pregnant mare. The breeder pasture bred, so couldn't give me an accurate foaling date. I felt the mare's udder, tail head, etc., and she didn't look like she was going to have that foal within a week, so we transported her home... a three hour ride. Got home around 10 PM, and it was really cold out, so we put her in a stall and figured we'd get her set up with monitoring equipment the next day "just in case." Went to the barn early the next morning and there was a dead foal laying there. So from that point on I have refused to let a mare leave here once she is past 5 1/2 months pregnant, and I won't bring one home that far along. I have no idea if the stress of being moved caused that other mare to spontaneously abort or what the case was.

Anyway, I'm surprised to hear you've had retained placentas for up to five days! I had no idea a mare could hang onto it that long without becoming very sick, but I suppose the penicillin is what keeps that from happening.

And of course we would not breed her this year. We may not breed her ever again, unless my vets absolutely assure me it's safe to do so. Of course, a lot of that also depends upon the outcome of this current problem, but when we left this morning the vets did ask us if we would be OK with it if she couldn't be bred again, and of course we would be! Just don't want to lose her!
 
Well, the vet could try flushing the uterous out. Usually we put a garden hose-sized tube in and run gallons of fluids through to try to wash it out. You absolutely should not pull it out; a vet will know just the right pressure to use to prevent tearing. Oxytocin and PGF2a will also help contract the organ, but won't always expel it if its attached strongly. Banamine to prevent toxic shock. Eventually it'll loosen and fall out, I hope. Best of luck, I'm sure your vet is taking good care of her
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Yes, the vet did run gallons of water into her uterus before we left this morning, and it didn't help. I do have a lot of faith in these vets. They have an excellent reputation as the *only* vets in the are that are exceptional when it comes to horses. People travel for hours to bring their horses to them. I still can't help being nervous. This mare is more like a pet dog to us than a brood mare!
 
Tell the vets to try the Burn's technique. It is where they would fill the placenta with saline fluid trying to create a type of "water balloon". This technique has been used on two of my mares and they expelled the placenta pretty quickly. Just had this done two weeks ago to a maiden mare that aborted and had to have the baby cut out at LSU, and in less that 10 minutes the placenta came out.
 
but when we left this morning the vets did ask us if we would be OK with it if she couldn't be bred again, and of course we would be! Just don't want to lose her!

I ask that question as well. Your answer leaves us a lot more room for treatment. There are some treatments that may be beneficial to the mare and not to the uterus, knowing where the owner stands takes off a lot of pressure.

Dr Taylor
 
Tell the vets to try the Burn's technique. It is where they would fill the placenta with saline fluid trying to create a type of "water balloon". This technique has been used on two of my mares and they expelled the placenta pretty quickly. Just had this done two weeks ago to a maiden mare that aborted and had to have the baby cut out at LSU, and in less that 10 minutes the placenta came out.
I believe the Burns technique has to be performed before six hours has passed. We had the vet come out and treat her and I gave her oxytocin the entire first day, and she wasn't brought to the hospital until 24 hours later, so it wouldn't be effective at this point.
 
but when we left this morning the vets did ask us if we would be OK with it if she couldn't be bred again, and of course we would be! Just don't want to lose her!

I ask that question as well. Your answer leaves us a lot more room for treatment. There are some treatments that may be beneficial to the mare and not to the uterus, knowing where the owner stands takes off a lot of pressure.

Dr Taylor
Well, this is Day 3. The vet called this morning and no change. At least my little mare doesn't have a temperature and is eating and drinking. Dr. Taylor, do you think there might still be a danger of metritis or founder, or might she be OK since she's not running a temp and seems fine in other respects?
 
They are likely giving Banamine to ward off founder.

One of the problems with early foal loss is that the foal is not ready to come out. Neither is the placenta. They were both meant to come out when they were full term.

We had a mare that we bought in foal abort six weeks before her due date last year. She did retain her placenta overnight and we had to have the vet come the next day and he was able to add fluid and remove the placenta. We had her on banamine and oral antibiotics for ten days. I actually started this before the vet came.

She is back in foal and we will see if we have a live one this year.

Do not give up hope. Let's get the mare through this first and wait and see.

My fingers are crossed for you as I can tell how much you love the mare and are putting her needs first. You are doing everything you can to save her and are doing everything right.

Thank you for sharing this with us at this difficult time. Please keep us posted.
 
They are likely giving Banamine to ward off founder.

One of the problems with early foal loss is that the foal is not ready to come out. Neither is the placenta. They were both meant to come out when they were full term.

We had a mare that we bought in foal abort six weeks before her due date last year. She did retain her placenta overnight and we had to have the vet come the next day and he was able to add fluid and remove the placenta. We had her on banamine and oral antibiotics for ten days. I actually started this before the vet came.

She is back in foal and we will see if we have a live one this year.

Do not give up hope. Let's get the mare through this first and wait and see.

My fingers are crossed for you as I can tell how much you love the mare and are putting her needs first. You are doing everything you can to save her and are doing everything right.

Thank you for sharing this with us at this difficult time. Please keep us posted.
Oh yes, I love this little mare like crazy! I know she is in good hands, but I can't help thinking of "worst case scenarios."

I was wondering... apparently they don't do D&Cs on mares like they do on people? I really don't know all that much about the aftermath of retained placentas because this is the first experience we've ever had with it.
 
Well, this is Day 3. The vet called this morning and no change. At least my little mare doesn't have a temperature and is eating and drinking. Dr. Taylor, do you think there might still be a danger of metritis or founder, or might she be OK since she's not running a temp and seems fine in other respects?
Probably won't founder or get toxic/septicemic, but she's got metritis. Her uterine lining is getting damaged, but it will likely only affect her breeding future, not her quantity/quality of life.

I would like to add that I seem to recall that you said you 'would only breed her if the Vet said it was safe'. This unfortunate situation only limits her ability to get pregnant. Her odds of dytocia or retaining a placenta in the future are no greater than a normal mare.

Dr Taylor
 
Oh yes, I love this little mare like crazy! I know she is in good hands, but I can't help thinking of "worst case scenarios."

I was wondering... apparently they don't do D&Cs on mares like they do on people? I really don't know all that much about the aftermath of retained placentas because this is the first experience we've ever had with it.
Brings up a good point.

There are actually 3 different types (I think) of placental-uterine junctions.

1)Cotyledons and caruncles of cattle, sheep, and goats

2)Spot attachments of pigs, dogs, cats, and humans

3)Broad but poor attachment of horses and other equine

Doing the same thing across species fails to realize this difference and how each different type works.

Dr Taylor
 
I believe the Burns technique has to be performed before six hours has passed. We had the vet come out and treat her and I gave her oxytocin the entire first day, and she wasn't brought to the hospital until 24 hours later, so it wouldn't be effective at this point.
There is no actual time limit on the use of the Burn's technique. The controlling factor is if the placenta is still able to hold the fluid and the cervix is still open enough to get in. I would say that by day three it would not work. By that time the placenta has started to breakdown creating holes and tears.

I recommend that anyone who has a mare that has not expelled the placenta within 3 hours have their vet try the Burn's technique. It may require some vets to do some research on how to do it. Not all vets are familiar with it.
 
Our vet uses a mixture which actually bubbles the utuerus clean - (much like vinegar and baking soda bubbles). He learned it from a repro specialist vet in TX. It has worked great for us here- really amazing. I will send you the information in a PM.
 
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Our vet uses a mixture which actually bubbles the utuerus clean - (much like vinegar and baking soda bubbles). He learned it from a repro specialist vet in TX. It has worked great for us here- really amazing. I will send you the information in a PM.
Thank you! Is this performed while the placenta is still retained, or after it's expelled?

And GOOD NEWS!!!!! My vet just called me and said while she was in the stall with the mare about 20 minutes ago she expelled the placenta, in its entirety! They will keep her today and tomorrow for uterine infusions and we will be able to bring her home late tomorrow afternoon, or perhaps after another infusion on Saturday morning, depending on test results. I'm a happy camper!
 
And GOOD NEWS!!!!! My vet just called me and said while she was in the stall with the mare about 20 minutes ago she expelled the placenta, in its entirety! They will keep her today and tomorrow for uterine infusions and we will be able to bring her home late tomorrow afternoon, or perhaps after another infusion on Saturday morning, depending on test results. I'm a happy camper!
Great News,
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There is no actual time limit on the use of the Burn's technique. The controlling factor is if the placenta is still able to hold the fluid and the cervix is still open enough to get in. I would say that by day three it would not work. By that time the placenta has started to breakdown creating holes and tears.

I recommend that anyone who has a mare that has not expelled the placenta within 3 hours have their vet try the Burn's technique. It may require some vets to do some research on how to do it. Not all vets are familiar with it.
Alright, I gotta admit, you got me. No, I had not heard of the 'Burn's Technique' so I had to look it up.

It was described by Burn's and others in 1977 at the AAEP convention. As in Vet medicine very little is described by the Dr of record's name, then I would doubt that many Vets would know what the Burn's technique describes. I give credit to your Vet for remembering that somewhat obscure reference.

Since 1977 uterine lavage has been used extensively for many reproductive conditions in many species. I do not know of nor was I able to find a reference that describes an increase in effect by lavaging the chorio-allantoic space rather than the uterus, not that it can't be tried. In the end the idea is to expand the uterus enough to disrupt the villous attachment to the placenta and no technique will do that 100% of the time.

Dr Taylor
 

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