46


EQUINE VETERINARY EDUCATION


Equine vet. Educ. (2020) 32 (1) 46-48 doi: 10.1111/eve.12876


Critically Appraised Topic


What is the best treatment for mares with post-partum haemorrhage?


P. A. Wilkins University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA. Corresponding author email: pawilkin@illinois.edu


Summary


Determining the ‘best’ treatment for mares with post-partum haemorrhage is a challenge for equine practitioners. There have been many approaches described, some directly contradictory, with scant evidence supporting choices made for treatment. Information available from peer-reviewed literature may be biased as reports primarily originate from large private or university-based referral hospitals. There are no large breeding farm population-based studies or studies directly comparing treatments.


PICO question


In mares affected by post-partum haemorrhage, is intensive medical therapy more effective than conservative therapy?


Search strategy CAB Abstracts on the OVID interface was searched from 1973 to 2017 using the following terms: (1) equine* OR horse* OR equus OR foal* OR colt* OR equid* OR mare or mares; (2) postpartum interval/OR postpartum period/OR parturition complications; (3) postpartum* OR post-partum* OR


postparturition* OR post-parturition* OR postparturient* OR post-parturient*); (4) haemorrhage/OR haemorrhagic colitis/ OR haemorrhage/OR haemorhag*.mp. OR hemorhag*.mp. OR haemorrhag*.mp. OR hemorrhag*.mp.; (5) drug therapy/OR treatment/OR therapy/OR surgical operations/OR surgery/ OR immunotherapy/OR medical treatment/OR treat*.mp. OR manag*.mp. OR therap*.mp. OR surg*.mp. OR med*.mp. OR drug*.mp. OR pharma*.mp. OR immuno*.mp. OR chemo*.mp; (6) 2 OR 3; (7) 1 AND 4 AND 5 AND 6; (8) limit 7 to English language; (9) 1 AND 4 AND 6; (10) limit 9 to English language. In total, 14 manuscripts were identified fulfilling the search


criteria for 7 and 8. Four were considered not applicable for a variety of reasons (wrong species; related to surgical intervention; not pregnancy related). Three were opinion- based reviews included in conference proceedings with an additional three being opinion-based reviews in peer- reviewed veterinary journals. Two were single case reports (Mogg et al. 2006; Oikawa et al. 2009) and two were retrospective university or large private referral hospital-based studies (Dolente et al. 2005; Arnold et al. 2008). A single retrospective university-based study yielded data on an additional three mares with peripartum bleeding out of 19 cases of haemoperitoneum (Pusterla et al. 2005). Of the two


TABLE 1: Treatments administered to mares suffering post-partum haemorrhage as reported in peer-reviewed retrospective studies and single case reports*


Reference


Arnold et al. (2008)


Study population and sample size


Private referral hospital 73 mares


Study design


Retrospective (1998–2005)


Treatments Flunixin meglumine


Polyionic crystalloid i.v. fluids Aminocaproic acid Sedation


Whole blood transfusion Hypertonic saline Pentoxyfylline Epidural


Naloxone Oxytocin


Plasma transfusion Laparotomy


Hb-based oxygen carrying solution Polymyxin B Hetastarch


Conjugated oestrogens


Yunan baiyao 10% formalin


Number treated (%)


72/73 (99) 69/73 (95)


67/73 (92) 51/73 (70) 33/73 (45) 33/73 (45) 32/73 (44) 29/72 (40) 24/73 (33) 14/73 (19) 11/73 (15) 6/73 (8) 5/73 (7)


4/73 (6) 4/73 (5) 2/73 (3)


2/73 (3) 1/73 (1)


Survival (%) NS


59/69 (86)


57/67 (85) NS


25/33 (76) 16/33 (48) NS NS


18/24 (75) 13/14 (93) 8/11 (73) 2/6 (33) 4/5 (80)


NS


3/4 (75) NS


NS NS


© 2017 EVJ Ltd


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