Prepubic Tendon Rupture
Introduction
This condition is most often seen in pregnant mares but can also occur in sheep and goats pregnant with multiple foetuses.
The prepubic tendon is a strong, thick, fibrous structure that attaches to the cranial border of the pubis and provides attachment for the rectus abdominus, oblique abdominal, gracilis and pectineus muscles.
Rupture of the tendon may occur singly or in combination with rupture of the rectus abdominus, transverse abdominus and oblique muscles. Ruptures may also occur one after the other.
This condition usually occurs in the last trimester of pregnancy as the foetus is growing at a rapid rate. It is more common in older, multiparous mares due to a weakened abdominal wall, and draught mares are predisposed. Hydroallantois, twins and inactivity have also been linked to the condition. However many cases occur with no apparent reason.
Clinical signs
Mares usually present close to foaling with severe ventral oedema running cranially from the udder. Unilateral oedema suggests partial rupture of the prepubic tendon, or damage to the ventrolateral body wall.
Affected mares have difficulty rising and are reluctant to move. Acute progression may result in distress, colic, tachypnoea, tachycardia, sweating, internal haemorrhage, shock and death.
Complete rupture results in tilting of the pelvis causing elevation of the tail head and tuber ischii and lordosis (sawhorse appearance).
The udder will also displace cranially and this helps to differentiate prepubic tendon rupture from abdominal hernia.
Diagnosis
Clinical signs are suggestive but the diagnosis may be difficult to confirm. The amount of oedema in the area usually makes transabdominal palpation very difficult.
Ultrasonography can be useful to determin abdominal rupture and incarceration of intestines.
Treatment
Any mare showing signs of ventral oedema should be confined to a box.
Treatment options depend on the value of the foal, the stage of the pregnancy, the age of the mare and the extent of damage to the abdominal muscles and prepubic tendon.
One option is to use supportive slinging of the abdominal wall until term. Pressure sores should be avoided and the padding should be replaced regularly. Some horses manage without support.
Inducing parturition if the foal is near term is another option. An assisted delivery will be necessary as the mare will be unable to exert sufficient abdominal pressure to expel the foal.
A caesarean section can also be considered if the well-being of the foal is of primary concern and the prognosis for the mare is poor. If abdominal defects cannot be repaired, euthanasia might be the most humane option.
In mares that survive delivery, care should be taken to evaluate the colostrum which will probably be of poor quality due to the udder oedema. Re-breeding is not recommended but embryo transfer can be used to continue the reproductive capacity of mares from superior bloodlines.
Repair of prepubic tendon ruptures is not possible, however if an abdominal rupture has also occured, surgical repair using mesh has been reported, and smaller ruptures may heal by second intention.
| Prepubic Tendon Rupture Learning Resources | |
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Equine Reproduction and Stud Medicine Q&A 13 |
References
McAuliffe, S. (2008) Color Atlas of Diseases of the Foal Saunders
McKinnon, O. (1998) Equine diagnostic ultrasonography Wiley-Blackwell
Orsini, J. (2008) Equine emergencies: treatment and procedures Elsevier Health Sciences
Knottenbelt, D. (2003) Equine stud farm medicine and surgery Elsevier Health Sciences
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