Changes

Also Known As – '''''Wind-sucking - Windsuckers'''''

Also Known As: '''''Wind-sucking — Windsuckers'''''

'''''Sequelae''''' – '''Placentitis – Endometritis – Vaginitis - Abortion'''

'''''Sequelae''''': '''Placentitis — Endometritis — Vaginitis — Abortion'''

==Introduction==

==Introduction==

Pneumovagina is usually a result of '''poor vulvar conformation''' in mares. It can be a significant contributor to '''ascending infection''' which can prevent '''establishment and survival of pregnancies. '''

Pneumovagina is usually a result of '''poor vulvar conformation''' in mares. It can be a significant contributor to '''ascending infection''' which can prevent '''establishment and survival of pregnancies. '''

==Signalment==

==Signalment==

'''Multiparous mares''' are more likely to suffer from the condition due to the stretching and trauma/scar related changes to the tissues.  

'''Multiparous mares''' are more likely to suffer from the condition due to the stretching and trauma/scar related changes to the tissues.  

A small proportion of horses affected are due to '''traumatic injury, most commonly caused by parturition''' due to positioning or posture of the foal at delivery.  

A small proportion of horses affected are due to '''traumatic injury, most commonly caused by parturition''', due to positioning or posture of the foal at delivery.  

==Pathogenesis==

==Pathogenesis==

When the '''vulvar commissure is below the pelvic brim''', often due to poor body condition and lack of fat\muscle around the hindquarters, the vulval lips often '''slope anteriorly and/or lie partially open with a poor seal''' and thus air enters. The '''negative pressure within the [[Reproductive System|reproductive tract]]''' then aids movement of the air into the vestibule, vagina and eventually cervix and uterus. This often makes a '''wind-sucking sound'''. A different, '''expulsory sound is often generated during movement''', as the air is expelled under force.  

When the '''vulvar commissure is below the pelvic brim''', often due to poor body condition and lack of fat\muscle around the hindquarters, the vulval lips often '''slope anteriorly and/or lie partially open with a poor seal''' and thus air enters. The '''negative pressure within the reproductive tract''' then aids movement of the air into the [[Vagina and Vestibule - Anatomy & Physiology|vestibule, vagina]] and eventually [[Cervix - Anatomy & Physiology|cervix]] and [[Uterus - Anatomy & Physiology|uterus]]. This often makes a '''wind-sucking sound'''. A different, '''expulsory sound is often generated during movement''', as the air is expelled under force.  

'''Faeces can also enter and contaminate''' a vulva that is sloped anteriorly in a similar way. This is an important source of infection which can then ascend the tract all the way to the uterus where it may prevent or terminate a pregnancy.

'''Faeces can also enter and contaminate''' a vulva that is sloped anteriorly in a similar way. This is an important source of infection which can then ascend the tract all the way to the uterus where it may prevent or terminate a pregnancy.

Chronic pneumovagina causes '''vaginal flatus, erythema of the vaginal mucosa''' and air within the tract which is palpable on rectal examination and visible upon ultrasound examination.  

Chronic pneumovagina causes '''vaginal flatus, erythema of the vaginal mucosa''' and air within the tract which is palpable on rectal examination and visible upon ultrasound examination.  

Ascending infection if left unchecked can lead to '''placentitis which is an important cause of abortion in the horse'''. Commonly implicated organisms include ''Streptococcus zooepidemicus , Escherichia coli , Klebsiella pneumoniae , Pseudomonas aeruginosa , Staphylococcus aureus , Rhodococcus equi'' , and ''Actinobacillus equuli.''

Ascending infection if left unchecked can lead to '''placentitis which is an important cause of abortion in the horse'''. Commonly implicated organisms include ''[[Streptococcus zooepidemicus]], [[Escherichia coli]], [[Klebsiella]] pneumoniae, [[Pseudomonas aeruginosa]], [[Staphylococcus aureus]], [[Rhodococcus equi]]'' , and ''[[Actinobacillus equuli]].''

Abortion may be the first sign in a mare that has not been previously examined or had a history of reproductive problems.

Abortion may be the first sign in a mare that has not been previously examined or had a history of reproductive problems.

'''Clinical signs''' are sufficient to diagnose pneumovagina.  

'''Clinical signs''' are sufficient to diagnose pneumovagina.  

Vulvae can be physically assessed in terms of '''position, slope and seal quality''', which aids in determination of risk. The '''Caslick index''' can be calculated by '''multiplying length of the vulva by angle of declination''' and values '''below 100 are favourable'''<ref name="Samper" />. Procedures can then be instigated to lower the risk to a developing pregnancy as discussed below in treatment.

Vulva can be physically assessed in terms of '''position, slope and seal quality''', which aids in determination of risk. The '''Caslick index''' can be calculated by '''multiplying length of the vulva by angle of declination''' and values '''below 100 are favourable''' and those more than 150 are classed as high risk for pneumovagina and infection<ref name="Samper" />. Procedures can then be instigated to lower the risk to a developing pregnancy as discussed below in treatment.

'''Examination of aborted foetuses''' will confirm presence of placentitis.  

'''Examination of aborted foetuses''' will confirm presence of placentitis.  

Many affected mares will have a history of subfertility, infertility or failed pregnancies.  

Many affected mares will have a history of subfertility, infertility or failed pregnancies.

==Treatment==

==Treatment==

There is little point or justification for treatment of uterine/vaginal infection and inflammation if the vulvar conformation is not corrected as recurrence is otherwise inevitable.  

There is little point or justification for treatment of uterine/vaginal infection and inflammation if the vulvar conformation is not corrected as recurrence is otherwise inevitable.  

'''Caslick’s operation or vulvoplasty''' of often the first line of treatment, '''closing the vulvar commissure partially''' to prevent contamination and air entry. The procedure is '''performed as soon as ovulation and breeding have been confirmed and sutures must be removed 5-10 days prior to parturition'''.  

'''Caslick’s operation or vulvoplasty''' are often the first line of treatment, '''closing the vulvar commissure partially''' to prevent contamination and air entry. The procedure is '''performed as soon as ovulation and breeding have been confirmed and sutures must be removed 5-10 days prior to parturition'''.  

'''Pouret’s operation''' is a more '''invasive''' procedure which separates the reproductive tract from the caudal [[Alimentary System|gastrointestinal tract]] and is usually reserved for '''very severe cases or where the Caslick’s has been unsuccessful'''.  

'''Pouret’s operation''' is a more '''invasive''' procedure which separates the reproductive tract from the caudal gastrointestinal tract and is usually reserved for '''very severe cases or where the Caslick’s has been unsuccessful'''.  

Intrauterine or systemic antibiotics and anti-inflammatory therapy are also usually indicated for any existing infection/inflammation and post-operative care.

Intrauterine or systemic antibiotics and anti-inflammatory therapy are also usually indicated for any existing infection/inflammation and post-operative care.

{{Learning

{{Learning

|flashcards = [[Pneumovagina in Horses Flashcards]]

|flashcards = [[Pneumovagina in Horses Flashcards]]<br>[[Equine Reproduction and Stud Medicine Q&A 06]]

}}

}}

Merck Veterinary Manual, '''Vulvitis and Vaginitis in Large Animals''', accessed online 24/07/2011 at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/111900.htm

Merck Veterinary Manual, '''Vulvitis and Vaginitis in Large Animals''', accessed online 24/07/2011 at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/111900.htm

[[Category:To Do - Manson review]] [[Category: Reproductive Diseases - Horse]]

 

 

 

[[Category:Expert Review - Horse]] [[Category: Reproductive Diseases - Horse]]