AMBULATORY PRACTICE


● Ultrasound machine ● 5- to 7-mHz linear transrectal probe ● 2- to 3.5-mHz transabdominal probe ● 10- to 14-gauge intravenous catheter ● Two 1-L bottles of 8% hypertonic saline ● 40 to 60 L of polyionic crystalloids ● High-flow fluid administration set ● Prostaglandin E (PGE) gela (if cervical dilation is desired)


● Brown gauze ● Lidocaine and scissors for episiotomy (“open” caslicks)


● Sterile gloves and sleeve ● 28F to 32F thoracic trocarc (sharp tip) ● Sterilized stomach tube ● 5-Gallon bucket ● Euthanasia solutiond ● Flunixin megluminee ● Sedation ● Detomidinef ● Romifidineg ● Xylazineh ● Prophylactic treatment with antibiotics ● Head snare ● Chains and handles ● Sterile lubricant


Evaluation of the Mare


Once a diagnosis of hydrops allantois or amnion is confirmed, fetal viability is determined, and the ud- der development and milk electrolytes (when war- ranted) will be assessed to estimate the level of fetal maturity. Client communication is critical to es- tablish the relative value of the mare or fetus, the risks posed to each, and the potential sequelae. Mares that present early in gestation may undergo elective termination of pregnancy by intramuscular injection of cloprostenoli (500 g IM q 12 h until delivery), as long as the amount of fluid is not too excessive to send the mare into shock with sponta- neous abortion. Cases that occur later in gestation, or those with profound abdominal enlargement with large volumes of fluid within the uterus, usually require controlled drainage of the hydropic fluid be- fore expulsion of the fetus to control cardiovascular shock. Mares that present during the last 2 to 4 weeks of pregnancy may be managed by conserva- tive therapy (maintain abdominal wrap for support, veterinary evaluation at least weekly, and have vet- erinary staff available for correction of dystocia and hypotensive shock) or partial drainage. The aim of the partial drainage is to maintain pregnancy for as long as possible for additional fetal maturation to occur. A physical exam of the mare will be per- formed along with complete blood cell count, fibrin- ogen, and serum biochemistry. In the authors’ experience, mares with high muscle enzymes (crea- tine kinase 1200 U/L) are at risk for rupture of


36 2013  Vol. 59  AAEP PROCEEDINGS


● or N-butylscopolammonium bromide gelb (compounded)


abdominal musculature or the prepubic tendon. These mares should have controlled drainage of the fluid because of the high risk for fatal complications. In our experience, it is not uncommon to have an animal that is hypocalcemic. Hypocalcemic pa- tients will be more vulnerable to hypotensive shock when the abdominal pressure is released during hy- dropic drainage. These animals may require intra- venous calcium supplementation before and during drainage. The placement of a large indwelling intravenous catheter (10- to 14-gauge) is important for the ad- ministration of polyionic crystalloid fluids while the allantoic or amnionic space is slowly drained. The amount of fluid administered intravenously that is needed to prevent hypotensive shock is dependent on how rapidly the hydropic fluids are drained. Initially, 10 L of fluids will be given during the first 30 to 60 minutes of the procedure. By the end of the procedure, it will not be uncommon to have administered an equivalent of one fourth of the vol- ume drained intravenously (ie, if 100 L was drained, then 25 L had been given intravenously over an 8- to 12-hour time interval). If the mare’s heart rate becomes greater than 56 to 60 bpm or the animal becomes ataxic or shaking, then the drain- age of hydropic fluids should be stopped and a bolus dose of colloids (Hetastarch,j 10 mL/kg IV) or 8% (2–4 mL/kg IV) hypertonic salinek will be warranted to correct the hypotension and normalize the heart rate.


Hydrops Drainage


The technique for drainage involves several consid- erations, with the most important being safety and comfort for both veterinarian and the patient. Lo- cation (stocks or stall) is determined by the individ- ual preference and the condition of the mare. The mare may have to be initially sedated and treated with flunixin meglumine (1 mg/kg IV) for ease of management. The tail should be wrapped and the perineal area should be surgically prepared. If present, the caslicks should be “opened.” Sterile technique should be followed during the procedure. Prostagladin Ea or N-butylscopolammoniumb bro- mide gel is gently massaged onto the cervix if cervical


dilation is desired. APGE1 gel can be made by crush- ing 200g of misoprostoll tablets, resuspending in 1.5 to 2 mL of saline, and further mixing with 1.5 to 2


mL of sterile lubricant. PGE2 gel may also be used.11 After 5 minutes, the cervix can be gently dilated manually. The veterinarian should be care- ful not to excessively dilate the cervix because he or she will not be able to control the rate of drainage of the fluid. If the veterinarian does not want to abort the fetus or induce the mare, then the dilation of the cervix may not be recommended. Once dilated, the mucus plug will be easily removed and the chorio- allantoic membrane can be palpated. The use of either a 28F or a 32F, sharp-tipped trocarc is then used to penetrate the chorioallantoic membrane


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