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Impressapaints

Retained Placenta (CVM??)

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Our mare foaled early yesterday morning, and has not passed her placenta yet, as of 6:00 this evening. Our vet has been out 3 times, she received two IM shots of pitocin yesterday morning. The vet has been unable to manually remove the placenta. I'm sure he's concerned, he just isn't showing it. He fully expects to get it tomorrow.

I have not been able to find anybody with experience in this. I've talked to several breeders, some of whom foal out dozens of mares every year, and the longest any of them had a mare retain was 7 hours. Google isn't any help either.

Our vet said he will lavage the uterus after he gets the placenta with antibiotics and to flush out any debris. She is on antibiotics orally right now.

My question is, besides founder and infection, what are the possible complications from this? Is this something life-threatening that we should consult a hospital about? Is my vet's course of action enough? Is there anything else we should be doing? Also, what is the worst case scenario?

Thank you so much.

Misti

[ 04-30-2007, 09:12 PM: Message edited by: Impressapaints ]

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Our mare foaled early yesterday morning, and has not passed her placenta yet, as of 6:00 this evening. Our vet has been out 3 times, she received two IM shots of pitocin yesterday morning. The vet has been unable to manually remove the placenta. I'm sure he's concerned, he just isn't showing it. He fully expects to get it tomorrow.

I have not been able to find anybody with experience in this. I've talked to several breeders, some of whom foal out dozens of mares every year, and the longest any of them had a mare retain was 7 hours. Google isn't any help either.

Our vet said he will lavage the uterus after he gets the placenta with antibiotics and to flush out any debris. She is on antibiotics orally right now.

My question is, besides founder and infection, what are the possible complications from this? Is this something life-threatening that we should consult a hospital about? Is my vet's course of action enough? Is there anything else we should be doing? Also, what is the worst case scenario?

Thank you so much.

Misti

[ 04-30-2007, 09:12 PM: Message edited by: Impressapaints ]

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It can be life-threatening if she gets an infection and/or laminitis. Is your vet experienced in equine reproduction? It needs to come out - sooner rather than later.

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It can be life-threatening if she gets an infection and/or laminitis. Is your vet experienced in equine reproduction? It needs to come out - sooner rather than later.

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Pitocin? Normally the drug of choice is Oxytocin. It can be given IM but I've only seen it given IV in this situation. You want the mare to have strong uterine contractions now. If the oxytocin didn't do the trick then the next step should of been to infuse the uterus with a few liters of warm Betadine solution. The fullness in her uterus will make it want to contract. You'll also have the added benefit of being able to add antibiotics to the uterus (oral antibiotics aren't going to slow down anything brewing in the uterus) and flush out any loose pieces.

She can go several days with no ill effects but I'd want it gone sooner. If you still can, tie the placenta just above the hocks to put some light pressure (just the weight of the mass hanging out) on it.

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Pitocin? Normally the drug of choice is Oxytocin. It can be given IM but I've only seen it given IV in this situation. You want the mare to have strong uterine contractions now. If the oxytocin didn't do the trick then the next step should of been to infuse the uterus with a few liters of warm Betadine solution. The fullness in her uterus will make it want to contract. You'll also have the added benefit of being able to add antibiotics to the uterus (oral antibiotics aren't going to slow down anything brewing in the uterus) and flush out any loose pieces.

She can go several days with no ill effects but I'd want it gone sooner. If you still can, tie the placenta just above the hocks to put some light pressure (just the weight of the mass hanging out) on it.

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Pitocin and oxytocin are the same thing [smile]

We tied the placenta up in a tight little bundle and wrapped her tail.

Thank you for the other suggestions! I'll mention it to my vet when I see him tomorrow.

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Pitocin and oxytocin are the same thing [smile]

We tied the placenta up in a tight little bundle and wrapped her tail.

Thank you for the other suggestions! I'll mention it to my vet when I see him tomorrow.

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I personally wouldn't have left that farm without the placenta being out. You're already at almost 36 hours post-foaling and you're rapidly approaching this mare getting systemically ill.

Manual removal of equine placentas is NOT ADVISED and is no longer considered 'standard of care'. This mare should be on antibiotics and Banamine as of 12 hours post-foaling. Management from here on it should consist of the placenta being bound tight to the vulva with weight in form of wet towels or water bottles attached. Start an IV drip of oxytocin for "constant rate infusion". Oxytocin is rapidly eliminated from the body so one injection doesn't last very long. My standard recommendation is if the mare doesn't pass the placenta within 4-6 hours, she gets an injection of oxytocin hourly for 3-4 doses. If it still hasn't passed by then, she gets an IV catheter and the constant infusion administered. If it still hasn't passed, a clean stomach tube is introduced into the center of the placenta and into the uterus, and a good 10-15 liters of fluid is pumped in to distend the uterus which will help release the microvilli of the placenta from the uterine wall. Manual removal (think peeling Velcro) of the placenta--especially one that is old and rotten--can and will leave microvillus lodged in the uterine wall. You'll remove the placenta, but leave these tissue tags, which is the biologic equivalent of the whole dang thing being left in.

Yes...this is potentially life-threatening, whether its directly from endotoxemia or indirectly due to laminitis. Again, I personally wouldn't have let this get past 24 hours, much less closing in on 72 hours.

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I personally wouldn't have left that farm without the placenta being out. You're already at almost 36 hours post-foaling and you're rapidly approaching this mare getting systemically ill.

Manual removal of equine placentas is NOT ADVISED and is no longer considered 'standard of care'. This mare should be on antibiotics and Banamine as of 12 hours post-foaling. Management from here on it should consist of the placenta being bound tight to the vulva with weight in form of wet towels or water bottles attached. Start an IV drip of oxytocin for "constant rate infusion". Oxytocin is rapidly eliminated from the body so one injection doesn't last very long. My standard recommendation is if the mare doesn't pass the placenta within 4-6 hours, she gets an injection of oxytocin hourly for 3-4 doses. If it still hasn't passed by then, she gets an IV catheter and the constant infusion administered. If it still hasn't passed, a clean stomach tube is introduced into the center of the placenta and into the uterus, and a good 10-15 liters of fluid is pumped in to distend the uterus which will help release the microvilli of the placenta from the uterine wall. Manual removal (think peeling Velcro) of the placenta--especially one that is old and rotten--can and will leave microvillus lodged in the uterine wall. You'll remove the placenta, but leave these tissue tags, which is the biologic equivalent of the whole dang thing being left in.

Yes...this is potentially life-threatening, whether its directly from endotoxemia or indirectly due to laminitis. Again, I personally wouldn't have let this get past 24 hours, much less closing in on 72 hours.

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I have copied and posted a comment from an equine reproduction message board about a similar situation. It echoes CVM's concerns and recommendations.

" In my opinion, oxytocin only stimulates the expulsion of placentae that are 'loose' within the uterus. The quicker the placenta is removed, the easier it is (unlike to cow) and it is now common practice to remove it by gentle and persistent traction while the mare is still down after foaling.

Placentae are retained either because the non-pregnant horn has contracted down tightly, gripping that portion of the placenta (hence the common problem of expulsion without part of the NPH) or are due to adhesion between the allantochorion and the endometrium.This latter cause is unusual but a major headache to treat. Probably best to expand the whole uterus by inserting a clean hose and clean water supply inside the allantochorion until the mare strains and refluxes it. Then hopefully the adhesions will be easier to separate manually.

Failure to remove the placenta within at most 24 hours, and in some cases much less (as little as 4 hours in heavy horses) risks uterine prolapse or serious endo/metritis and consequent laminitis. In my opinion if the mare has not clensed within 4 hours veterinary help should be sought. If oxytocin does not work straight away then manual removal should be considered as early as possible. The longer it is left, the harder it is to remove and the greater the adverse consequences. Any delayed expulsion or any manual interference should be followed by intrauterine antibiotics to which E. coli should be sensitive. In my opinion it may not be necessary to given parenteral antibiosis unless sepsis has already set in, however intrauterine treatment is an essential preventative."

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I have copied and posted a comment from an equine reproduction message board about a similar situation. It echoes CVM's concerns and recommendations.

" In my opinion, oxytocin only stimulates the expulsion of placentae that are 'loose' within the uterus. The quicker the placenta is removed, the easier it is (unlike to cow) and it is now common practice to remove it by gentle and persistent traction while the mare is still down after foaling.

Placentae are retained either because the non-pregnant horn has contracted down tightly, gripping that portion of the placenta (hence the common problem of expulsion without part of the NPH) or are due to adhesion between the allantochorion and the endometrium.This latter cause is unusual but a major headache to treat. Probably best to expand the whole uterus by inserting a clean hose and clean water supply inside the allantochorion until the mare strains and refluxes it. Then hopefully the adhesions will be easier to separate manually.

Failure to remove the placenta within at most 24 hours, and in some cases much less (as little as 4 hours in heavy horses) risks uterine prolapse or serious endo/metritis and consequent laminitis. In my opinion if the mare has not clensed within 4 hours veterinary help should be sought. If oxytocin does not work straight away then manual removal should be considered as early as possible. The longer it is left, the harder it is to remove and the greater the adverse consequences. Any delayed expulsion or any manual interference should be followed by intrauterine antibiotics to which E. coli should be sensitive. In my opinion it may not be necessary to given parenteral antibiosis unless sepsis has already set in, however intrauterine treatment is an essential preventative."

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I haven't spoken with my vet this morning, he is super busy, but I emailed him both of your responses. Thank you. I know this sounds silly, but I'm so afraid of offending him. On the one hand, he's been my vet for years, and I send him Christmas cards every year. But on the other, this is my mare we're talking about. [Frown]

His wife, who answered his phone, said he's only balling up what is out, that it's slowly coming out and he is balling it up closer to the vulva. He hasn't attempted to go in and remove it, contrary to what I had been told by my mom and her friend. These instructions you have given me aren't much different from what he's been doing, just more aggressive.

I'm calling some more vets in case he disregards the instructions. Thank you all for your help!

Misti

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I haven't spoken with my vet this morning, he is super busy, but I emailed him both of your responses. Thank you. I know this sounds silly, but I'm so afraid of offending him. On the one hand, he's been my vet for years, and I send him Christmas cards every year. But on the other, this is my mare we're talking about. [Frown]

His wife, who answered his phone, said he's only balling up what is out, that it's slowly coming out and he is balling it up closer to the vulva. He hasn't attempted to go in and remove it, contrary to what I had been told by my mom and her friend. These instructions you have given me aren't much different from what he's been doing, just more aggressive.

I'm calling some more vets in case he disregards the instructions. Thank you all for your help!

Misti

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Ditto to daisysmom. I worked a ranch where all the mares one year retained their placentas. It was caused by lack of vitamin E in their diet.

quote:

Originally posted by daisysmom:

Pitocin? Normally the drug of choice is Oxytocin. It can be given IM but I've only seen it given IV in this situation. You want the mare to have strong uterine contractions now. If the oxytocin didn't do the trick then the next step should of been to infuse the uterus with a few liters of warm Betadine solution. The fullness in her uterus will make it want to contract. You'll also have the added benefit of being able to add antibiotics to the uterus (oral antibiotics aren't going to slow down anything brewing in the uterus) and flush out any loose pieces.

She can go several days with no ill effects but I'd want it gone sooner. If you still can, tie the placenta just above the hocks to put some light pressure (just the weight of the mass hanging out) on it.

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Ditto to daisysmom. I worked a ranch where all the mares one year retained their placentas. It was caused by lack of vitamin E in their diet.

quote:

Originally posted by daisysmom:

Pitocin? Normally the drug of choice is Oxytocin. It can be given IM but I've only seen it given IV in this situation. You want the mare to have strong uterine contractions now. If the oxytocin didn't do the trick then the next step should of been to infuse the uterus with a few liters of warm Betadine solution. The fullness in her uterus will make it want to contract. You'll also have the added benefit of being able to add antibiotics to the uterus (oral antibiotics aren't going to slow down anything brewing in the uterus) and flush out any loose pieces.

She can go several days with no ill effects but I'd want it gone sooner. If you still can, tie the placenta just above the hocks to put some light pressure (just the weight of the mass hanging out) on it.

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it's out!! Yay! She and the foal had their first outing in the arena yesterday. Boy, was that cute. He was bolting around, stretching those loooooong legs for the first time, and she was right behind him, yelling at him the whole time.

Thank you for the help. It slipped right out this morning. The exercise yesterday must have helped it come free.

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it's out!! Yay! She and the foal had their first outing in the arena yesterday. Boy, was that cute. He was bolting around, stretching those loooooong legs for the first time, and she was right behind him, yelling at him the whole time.

Thank you for the help. It slipped right out this morning. The exercise yesterday must have helped it come free.

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Now you need to monitor her for a uterine infection. (it's always something) I'd still have the vet out for an antibiotic flush and fill. Hooray it resolved itself.

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Now you need to monitor her for a uterine infection. (it's always something) I'd still have the vet out for an antibiotic flush and fill. Hooray it resolved itself.

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The placenta may be out now, BUT your fight may have JUST begun. I would get to another vet and have her flushed and maybe infused as well for three days.

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The placenta may be out now, BUT your fight may have JUST begun. I would get to another vet and have her flushed and maybe infused as well for three days.

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Impressa.. I spoke to one of my vets, Dr. Rene Andrea. She is a phenominal surgeon. She suggested that you get ahold of Dr Delany (spelling??) and/or Dr. Bleak. Their's is a joint practice based out of Chino Valley. Dr. Andrea couldn't remember the name of their clinic, but thought either of them would be a good choice for the continued care of your mare.

Also... She was very concerned about the length of time she was allowed to go without shedding her placenta. She said that if it were her own horse, she would want her at the clinic where she could be closely monitored and treated around the clock. Needless to say, she was VERY concerned.

You have my number, call if you need anything.

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Impressa.. I spoke to one of my vets, Dr. Rene Andrea. She is a phenominal surgeon. She suggested that you get ahold of Dr Delany (spelling??) and/or Dr. Bleak. Their's is a joint practice based out of Chino Valley. Dr. Andrea couldn't remember the name of their clinic, but thought either of them would be a good choice for the continued care of your mare.

Also... She was very concerned about the length of time she was allowed to go without shedding her placenta. She said that if it were her own horse, she would want her at the clinic where she could be closely monitored and treated around the clock. Needless to say, she was VERY concerned.

You have my number, call if you need anything.

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We put it in a garbage bag and had our vet check it out when he came out yesterday. He flushed her with Betadine and antibiotics.

I forwarded your messages to my mom. I just talked to her about it, as a matter of fact, and she says she's leaving the mare as she is, with the oral antibiotics. The most frustrating thing is not having control. If it were my horse, I would have her at the clinic. But I don't control the financial portion, and it's an incredibly helpless feeling to be in this position. [bang Head][bang Head][bang Head][bang Head][bang Head][bang Head][bang Head][bang Head]

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We put it in a garbage bag and had our vet check it out when he came out yesterday. He flushed her with Betadine and antibiotics.

I forwarded your messages to my mom. I just talked to her about it, as a matter of fact, and she says she's leaving the mare as she is, with the oral antibiotics. The most frustrating thing is not having control. If it were my horse, I would have her at the clinic. But I don't control the financial portion, and it's an incredibly helpless feeling to be in this position. [bang Head][bang Head][bang Head][bang Head][bang Head][bang Head][bang Head][bang Head]

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