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| − | '''A foaling mare is presented with dystocia. A manual examination finds a live foal in normal presentation; however, your findings indicate a caesarean section is likely to be the most successful means of delivery of a live foal.''' | + | ''' |
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| | <FlashCard questions="4"> | | <FlashCard questions="4"> |
| − | |q1= What conditions in the mare and foal would indicate the need for a caesarean section? | + | |q1= |
| − | |a1= (1) A narrow pelvic canal; (2) an oversize foal; (3) a malpositioned live foal which cannot be manipulated to the normal position; (4) arthrogryposis; (5) dead foals where a fetotomy cannot be performed safely; (6) rupture of the abdominal musculature. | + | |a1= |
| | |l1= | | |l1= |
| − | |q2= What surgical approaches can you use? | + | |q2= |
| − | |a2= (1) Low left flank approach is useful in large draught mares with large foals. An advantage is less myositis than when the mare is in dorsal recumbency; disadvantages are limited exposure; it is more difficult for deformed foals and for uterine torsion. | + | |a2= |
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| − | (2) Caudal ventral midline approach. Advantages are it is a common familiar site for surgery, there is little haemorrhage from linea alba and exposure is better; disadvantages are the possibility of myositis from prolonged recumbency on the back muscles and it is more difficult to lift the foal out of the abdomen.
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| | |l2= | | |l2= |
| − | |q3= What complications can occur in mares during caesarean section and how would you manage them? | + | |q3= |
| − | |a3= (1) Contamination of abdominal cavity by uterine contents: expose the uterus and locate the feet, pull the uterus up and pack off with drapes; a heavy stay suture can also be placed each end of the intended incision to hold the uterine edges up after delivery of the foal. | + | |a3= |
| − | (2) Tearing of the uterine wall due to too small an incision: make sure the uterine incision is enlarged by surgical cut, not tearing.
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| − | (3) Control of uterine haemorrhage (which can be profuse): if the placenta is easily detached, remove it; if not, free back the placenta for 3 cm around the rim of the incision and place a continuous suture along each edge of the incision to control haemorrhage. Be very careful not to include allantochorion in the sutures.
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| − | (4) Leakage of uterine lochia: use an appropriate suture pattern to close the incision.
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| − | (5) Peritonitis from uterine lochia: lavage the abdominal cavity with warm normal saline and aspirate; a final wash should contain penicillin and gentamycin.
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| | |l3= | | |l3= |
| − | |q4= What post-operative complications can occur and how would you manage them? | + | |q4= |
| − | |a4= A retained placenta: | + | |a4= |
| − | (1) IV drip oxytocin 50 IU in 1 litre of saline solution over 1 hour if the placenta is not passed during the anaesthetic recovery period or use 20–40 IU oxytocin IM every hour.
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| − | (2) Contamination infection of the vagina, cervix and uterus: where trauma to the vagina, cervix, etc. has occurred prior to caesarean section, and with prolonged placental retention, use gentle uterine lavage with warm normal saline commencing 24 hours post-operatively; avoid over-distension.
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| − | (3) Postsurgical dehydration and infection: use IV fluids, parenteral antibiotics and NSAIDs for 3–5 days. Reassess the need for further treatment each day.
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| − | (4) Post-surgical ileus and/or constipation: use a laxative diet and make sure the mare drinks water or is given IV fluids.
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| − | (5) Swelling of limbs: increase hand walking exercise or turn out in a small paddock 3–4 times daily.
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| − | (6) Post-surgical complications related to any abdominal surgery: incisional infection, wound dehiscence, colic due to bowel injury during parturition or during surgery and laminitis.
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| | |l4= | | |l4= |
| | </FlashCard> | | </FlashCard> |
