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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.''' | | '''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= What conditions in the mare and foal would indicate the need for a caesarean section? |
− | |a1= (1) A narrow pelvic canal; (2) an oversize foal; (3) a malpositioned live foal | + | |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. |
− | 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. | |
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| |q2= What surgical approaches can you use? | | |q2= What surgical approaches can you use? |
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| |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= (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. |
| (2) Tearing of the uterine wall due to too small an incision: make sure the uterine incision is enlarged by surgical cut, not tearing. | | (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. | | (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. | | (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. | | (5) Peritonitis from uterine lochia: lavage the abdominal cavity with warm normal saline and aspirate; a final wash should contain penicillin and gentamycin. |
| |l3= | | |l3= |
| |q4= What post-operative complications can occur and how would you manage them? | | |q4= What post-operative complications can occur and how would you manage them? |
− | |a4= A retained placenta: (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. | + | |a4= A retained placenta: |
| + | (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. |
| (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. | | (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. | | (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. | | (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. | | (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. | | (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. |
| |l4= | | |l4= |