Changes

Caesarean section can be the best method of delivery for various types of dystocia in the mare, especially in cases where the foetus cannot be easily repositioned ('''transverse presentation'''), or where the foetus is '''grossly oversized''' relative to the mare's birth canal.

Caesarean section can be the best method of delivery for various types of dystocia in the mare, especially in cases where the foetus cannot be easily repositioned ('''transverse presentation'''), or where the foetus is '''grossly oversized''' relative to the mare's birth canal.

'''Congenital deformities''' such as schistosomus reflexus or arthrogryposis may also be an indication for caesarean section.

'''Congenital deformities''' such as schistosomus reflexus or [[arthrogryposis]] may also be an indication for caesarean section.

It may also be the safest method of delivery for '''dead foals''', where foetotomy is difficult, or in cases of '''[[Prepubic Tendon Rupture|prepubic tendon rupture]]'''.

It may also be the safest method of delivery for '''dead foals''', where foetotomy is difficult, or in cases of '''[[Prepubic Tendon Rupture|prepubic tendon rupture]]'''.

Caesarean section should not be considered as a last resort and should be carried out '''promptly''', preferably within an hour of the onset of stage 2, because '''placental separation''' will be occurring at a significant rate.

Caesarean section should not be considered as a last resort and should be carried out '''promptly''', preferably within an hour of the onset of stage 2, because '''placental separation''' will be occurring at a significant rate.

==Anaesthesia and surgical preparation==

==Anaesthesia and Surgical Preparation==

'''Foetal depression''' should be minimised during the anaesthetic.

'''Foetal depression''' should be minimised during the anaesthetic.

The '''sites''' commonly used for caesarean section include:

The '''sites''' commonly used for caesarean section include:

:'''Ventral midline''': which requires general anaesthesia and is a common surgical site

:'''Ventral midline''': which requires general anaesthesia and is a common surgical site

:'''Paramedian''': can be useful if the midline has previous laparotomy incidions

:'''Paramedian''': can be useful if the midline has previous laparotomy incisions

:'''Low left flank''': with the mare standing, but there is limited exposure and access

:'''Low left flank''': with the mare standing, but there is limited exposure and access

If the ventral midline approach is chosen, the mare is placed in '''dorsal recumbency''' and is clipped and prepared for aseptic surgery in a routine manner.

If the ventral midline approach is chosen, the mare is placed in '''dorsal recumbency''' and is clipped and prepared for aseptic surgery in a routine manner.

'''Fluid therapy''' should be given.

[[:Category:Fluid Therapy|'''Fluid therapy''']] should be given.

==Surgical technique==

==Surgical Technique==

Through the ventral midline incision, the uterus is located and an incision site over a limb is chosen.

Through the ventral midline incision, the uterus is located and an incision site over a limb is chosen.

'''Penicillin and gentamycin''' can be instilled in the final wash as a special precaution.

'''Penicillin and gentamycin''' can be instilled in the final wash as a special precaution.

==Post-operative management==

==Post-Operative Management==

'''Tetanus prophylaxis, antibiotics and oxytocin''' are administered and fluids are continued until the mare is recovered.

'''[[Tetanus - Horse|Tetanus]] prophylaxis, antibiotics and oxytocin''' are administered and fluids are continued until the mare is recovered.

'''Colostrum''' should be obtained as soon as possible to administer to the foal and the foal should be introduced to the mare as soon as she is steady on her feet.  

'''Colostrum''' should be obtained as soon as possible to administer to the foal and the foal should be introduced to the mare as soon as she is steady on her feet.  

'''Rectal examination''' for the next 5-7 days will help assess uterine size and involution.

[[Rectal Examination of the Horse|'''Rectal examination''']] for the next 5-7 days will help assess uterine size and involution.

'''Common complications''' following surgery include:

'''Common complications''' following surgery include:

:'''retained placenta''' due to uterine atony following extended uterine manipulation: place on oxytocin drip

:'''Retained placenta''' due to uterine atony following extended uterine manipulation: place on oxytocin drip

:uterine and vaginal infections: gentle uterine lavage with saline

:Uterine and vaginal infections: gentle uterine lavage with saline

:'''post-surgical ileus''' and constipation: ensure sufficient fluids and give motility-enhancing drugs

:'''Post-surgical ileus''' and constipation: ensure sufficient fluids and give motility-enhancing drugs

:'''limb swelling''': gradually increase hand walking and paddock turnout

:'''Limb swelling''': gradually increase hand walking and paddock turnout

:'''incisional problems''' such as infection, dehiscence: treat accordingly

:'''Incisional problems''' such as infection, dehiscence: treat accordingly

:'''adhesions and colic''': may need another surgery or adhesions may be broken down during rectal exam

:'''Adhesions and colic''': may need another surgery or adhesions may be broken down during rectal exam

The earlier the operation is carried out the better the prognosis, and caesarean sections can have very good outcomes with both mare and foal recovering. Successful outcome percentages fall as mares reach 20-25 years of age.

The earlier the operation is carried out the better the prognosis, and caesarean sections can have very good outcomes with both mare and foal recovering. Successful outcome percentages fall as mares reach 20-25 years of age.

[[Category:To Do - Helen]]

[[Category:To Do - Review]]

[[Category:Surgery]]

[[Category:Expert Review - Horse]]