Changes

==Introduction==

==Introduction==

The so-called foot-nape posture.

A recto-vaginal fistula can be caused during foaling by the so-called '''foot-nape posture'''.

This occurs when the foal is presented with the legs forward without the head. The long limbs and relatively slender head of the foal make this posture feasible in the mare. The foot of the foal is directed dorsally by the transverse fold between vagina and vestibule. After a long period of severe non-productive straining, a foot-nape posture may lead to a rectovaginal fistula or eventually a third degree perineal laceration. In these cases both the dorsal vaginal wall and rectum are penetrated.

This occurs when the '''foal''' is presented with the '''legs forward''' '''without the head'''. The long limbs and relatively slender head of the foal make this posture feasible in the mare. The foot of the foal is directed dorsally by the transverse fold between vagina and vestibule. After a long period of severe non-productive straining, a foot-nape posture may lead to a '''rectovaginal fistula''' or eventually a '''third degree perineal laceration'''. In these cases both the dorsal vaginal wall and rectum are penetrated.

==Signalment==

==Signalment==

It is most common in primiparous mares. It is generally caused by a combination of poor alignment of the foal and excessive straining by the mare.

It is most common in '''primiparous''' mares. It is generally caused by a combination of '''poor alignment''' of the foal and '''excessive straining''' by the mare.

==Treatment==

==Treatment==

If possible, it is important to keep the animal on her feet, and quiet walking may decrease straining efforts. Reposition is first attempted after epidural anaesthesia (which prevents straining). The foal is forcefully repelled and if possible the foreleg(s) are lifted and placed underneath the head. Lubricant and snares may be required to achieve this. If this is not successful and the foal is still alive, incision of the perineum may be necessary before extraction of the fetus. If the fetus is dead a quick partial fetotomy is indicated. The feet can be sectioned in the radius after which a careful extraction will be possible. The traumatised tissue should be checked for bleeding, and devitalised tissue removed. Final repair of the perineal laceration may be best delayed until weaning of the foal, i.e. at least a few months after parturition.

If possible, it is important to keep the animal on her '''feet''', and quiet walking may decrease straining efforts. Reposition is first attempted after '''epidural anaesthesia''' (which prevents straining). The foal is '''forcefully repelled''' and if possible the '''foreleg(s)''' are '''lifted''' and '''placed underneath the head'''. Lubricant and snares may be required to achieve this. If this is not successful and the foal is still alive, '''incision of the perineum''' may be necessary before extraction of the fetus. If the fetus is '''dead''' a quick partial '''fetotomy''' is indicated. The feet can be sectioned in the radius after which a careful extraction will be possible. The traumatised tissue should be checked for '''bleeding''', and '''devitalised tissue removed'''. '''Final repair''' of the perineal laceration may be best delayed until '''weaning of the foal''', i.e. at least a few months after parturition.

==Prognosis==

==Prognosis==

Although the function of the anal sphincter is not always completely restored, the prognosis for surgical restoration of the rectal and vaginal wall a few months after birth is good.

Although the function of the anal sphincter is not always completely restored, the prognosis for surgical restoration of the rectal and vaginal wall a few months after birth is '''good'''.

==References==

==References==