OK, so, welcome to everyone. I'm aware that some of you might be watching this as a recording of the webinar. So I hope you find this interesting.
So, in terms of, I was asked to get some learning outcomes together, so I thought it was just a good opportunity to just make sure that people know the kind of things that I will be going through, and they can largely be broken up into those emergencies related to females, which obviously is primarily related to mares either during pregnancy, during part tuition, or in that early post-parturian period, or for male emergencies, these are sort of really mainly focused around castration and those complications that occur immediately following it. But also in those horses that develop reproductive emergencies related to the male reproductive tracts, these would primarily be related to breeding stallions or cults, but occasionally would also relate to gelding. So I've got quite a few topics to cover, but I'm just going to go through sort of the main ways of identifying and managing and including the treatment of a variety of reproductive emergencies.
OK, so coming on to the mayor first, I would say, obviously, most of these problems are related to that sort of period of time around foaling and those few days immediately following foaling. Obviously, there are problems. That can occur during pregnancy.
for example, uterine torsion, causing low grade signs of colic and some other colic signs, but most of the emergencies, that we are dealing with are, are around that very specific time period and directly at the time of falling. So there's quite a number of conditions that would be on our list of things to manage. I put sort of the, I suppose the most immediately life-threatening ones either to the mayor, .
To the fall in the case of dystopia, but, you know, other complications will occur and obviously will be potentially life-threatening if they're not dealt with properly, particularly things like retained foetal membranes and bladder prolapse, whereas some of your other complications that might occur wouldn't be life-threatening, but some certainly would lead to compromise of the mare's reproductive tract. So I guess that's where Management of our emergencies in the mare, sort of separates out a little bit. We're either trying to save a life, either of the mare or the foal or both.
But remember, in your valuable breed bear, you're not just interested in, in that foal, you're, considering that mare's, future breeding, soundness, which is, obviously equally as important. So the first one to cover, which I think is probably the one that is most immediate and certainly life-threatening to the foetus, and that's dystopia. And I'm aware that we've got quite a mixed audience, from, a very wide geographical area.
So, some of you might be dealing with, mares, you know, quite valuable mares. On very well managed and stud farms, right through to those of you who might be managing pregnant horses and potentially donkeys, you know, that have, you know, a single horse within a, in a family with people who might not be aware what to do, when to call the vets, and a very different circumstances of what's available to you. So most of what's in the literature obviously is sort of based around the sort of the optimal care for that very well managed sort of stud farm with a referral centre and the option to do surgery.
But I'll mention some sort of little tips and tricks that you could do in the field if you don't have those, facilities available. The critical thing is that the owner of the pregnant mare appreciates that time is critical and that obviously veterinary attendance is sought quickly and arrives quickly or advice is given quickly, because we know that the longer that stage two of labour goes on, and that the less likely the foal is going to be to survive. And then all those other complications related to Having a very sick mayor, could then, threaten the mayor's, life itself, or could lead to a reduced chance that that mayor will be, become pregnant again.
So there are lots of things that we, we have to, try and sort of think about and manage. And of course, there are some situations where, the impetus might be to save the fold more so than to save the mayor or vice versa. So, owners of pregnant mares should be aware of the signs to look for.
A lot of, obviously valuable, breed mares would be, at stud farm where most, workers, around the mare are completely au fait with what's normal, what's not normal, when to seek help, and, everything happens very quickly. Some problems can arise when you do have mares falling at home with owners who are less experienced, and that is where it's quite important, I think, for owners just to make sure they know what they're doing. And if they don't know what they're doing and they're not able to adequately monitor those horses, to consider that sending them to a stud to fall, or make sure that they at least read up things and have a plan and know what to do.
So the history with these ones would be a mare who is at late gestation, expected stage of part tuition. I guess you might have that mare that aborts during an earlier stage of pregnancy, just something to be aware of, and that obviously opens up a whole different ball game of causes of abortion and those infectious and non-infectious causes. But that the mayor who's gone into stage one, labour, then doesn't progress as expected with normal appearance of the foetal limbs and the amniotic sack, and, the mayor is continuing to look uncomfortable and to strain.
So that's the, the point at which owners, of stud farm, personnel would need to call in, veterinary assistant assistance quickly. And the time really is the critical thing, because you do need to intervene promptly to make sure that that foetus has the best possible chances of surviving. But one of the emergency situations where you don't have even the time to necessarily get there.
To assist the mayor is what we call a red bag delivery where there's premature placental separation and you get to see the, the red velvety and sort of coo on toast and be presented, and it is imperative to get that full out really, really quickly. And I think these are always quite difficult things to describe. And for my student teaching, actually, some of the resources I've found most useful were some videos that are freely available on YouTube, which quite nicely, and probably owners who aren't sure what to expect, what to do, probably could find some very useful resources from very well managed and stud farms as to what's normal, what's not normal, and recognising these red.
Bags red bag deliveries. And basically, you may need to stay on the phone to guide an owner through this, and you'll see if you look at these videos, just very simply, they may sometimes open up sort of spontaneously, but if, if not, just going in very quickly with a pair of scissors just to snip open and grab the foetal limbs and heads and deliver that file as quickly as possible. So just some, some interesting resources that that are out there, because they are otherwise quite difficult to, describe to an owner or, or even a training vets.
So coming on to dystopia, the types of things that might cause dystopia are broadly separated into the mare related factors or those related to the foetus. And I think it's always quite useful. I always teach students that really, folding is no different to a lambing or a carving.
It's just you might have a slightly more valuable mare potentially to deal with, but obviously, the cattle, some of those cows might be equally as valuable. But, you may have, all the, all the similar types of different fetals sort of position, posture, and presentation. But just a few, subtle little differences, one of which being that, the mayor obviously has the ability to potentially kick and, cause, injury to personnel, and also compared to certainly Catal and .
Potentially sheep, although they're smaller. There's a lot less room, there's a lot more straining of the abdomen and a lot less room, and your foal has got much longer limbs and a longer neck to deal with. But otherwise, the basic principles are still the same.
Mayors, we know that mayors who've had a prior pelvic injury, anything that narrows that birth canal could potentially be at greater risk of dystopia, and obviously knowing whether a mare has foaled before or not and whether any problems have been encountered is important in your history. And this may show, which has got a very classic pre-pubic tendon rupture, these are mares that do require usually assistance at the time of parturition. And can be quite complex to deal with.
You can, have all sorts of catastrophes, with acute rupture of the body wall. So, I thought my email was turned off, and, you know, those, those ones do need to be hospitalised and monitored quite carefully. So in terms of foetal factors, position, posture, and presentation are just exactly the same as you would deal with with other species.
But one thing to note is that foetal oversize is relatively, less common, than certainly, like your cattle or, your sheep. And these are just some deformities, and you'll always get something a little bit bizarre, potentially, where you think, you know, it's presented normally, why isn't it coming out? So just be aware, there's always, there's always something that hasn't read the textbook and and anything can go.
All right, so in terms of your initial assessment, this should be quick, time yourself, get somebody who's not directly involved with holding on to the mayor and to get to to time you. So you want to get a quick history, obviously checking that, you know, mayor is expected to fold at this time, if she's fold previously and if there were any particular issues during then. And that temptation is always to quickly head to that back end, start quickly doing everything, but remember that you need to assess the mayor's systemic status to check, that heart rates is normal, and just to determine whether this mayor is systemically well or if you're dealing with a mayor that's sick and might be showing signs of shock.
If you've got a fractious mare and sometimes it's just a little bit easier just to stop, straying when you get called out to see this mare with dystopia. Any of the alpha 2 agonists obviously will have an impact on foetus as well. So, I don't think there's any, golden rules about which one to use because they all have effects, but generally because xylazine is quicker acting and is a shorter duration, then, that would be the one that probably most people would choose.
So you want to perform your initial vaginal examination. And again, make sure that you're doing this in a hygienic fashion. Obviously, it's just a sort of basic premise, but will potentially have an impact on the mare's future fertility, she developed some horrific infection.
So you want to make sure your hands are washed and those of any assistance. Some people will wear rectal sleeves with sort of surgical gloves on the end, or some people may choose to do this bare arm, but as I said, make sure that you're clean, and that you've cleaned a bandaged the tail, cleaned the mare's perineum. And you're going to perform this vaginal examination just to determine whether that normal position of the two forelimbs and the head there, or whether you've got something else like a transverse or a posterior presentation.
And you need to try and work out if the foal is still alive, which can sometimes quite difficult, obviously, if they sort of pull a limb back in response to your palpation. That's quite easy, but, if you're not sure, then, ultrasonography can be a useful tool, a trans transabdominal to try and see if you can see a foetal heart rate. Obviously, time is of the elements and you know, it, it may be that you don't have those resources available to you or, or that you do.
So, you're then going to potentially put on, ropes, just put a half hitch over the, just above the fat locks, and you can put a rope, head rope, a lot of people use just a simple rope just around the mandible, but this is purely for guiding, the position of the head, just to make sure it doesn't slip backwards, and certainly not to put traction on because, those structures are very delicate and most of the traction should go through the, the limbs. So I'm not gonna go through in that in a huge amount of detail because it's very sim sim similar to the principles of other large animal species. But just to go through the options for managing this mare with dystopia, and there are lots of practical issues and very different scenarios which are going to be very unique, to each individual fold, particularly if they're not on your conventional, very well managed stud farm that has a surgical equine facility just down the road.
So you need to think about expertise available, either your expertise or expertise available to you, what facilities, whether there's transport at the there. Obviously economics comes into play, you know, how much an owner wants to spend, obviously, whether the foal is alive or dead at the time of you performing your initial examination. And, you know, the health of the mare, this might be a very old brood mare that was going to be her last, reproductive season, so, .
Those are all the things that you want to, want to consider. So we're going to break this down into sort of three main things, your, assisted, vaginal delivery. I I haven't written it out in full because we'll run through each of those, your controlled vaginal delivery, or going into your sort of traditional caesarean section, and then I'll just mention some of the other options, at the very end.
So with your assisted vaginal delivery, the mayor is conscious, which is what differentiates it from your controlled vaginal delivery. So you're helping the mayor using, you know, any sort of straining that she might provide, but obviously, conversely, that can actually make life a little bit more difficult. The mayor might be standing or she might be recumbent, which obviously makes sometimes makes life more easy or more difficult depending on the mayor.
And as I've already described, that you, deliver the foal using traction or ropes. And again, it's really important that you're timing yourself, after your initial assessment, which should only take 10 minutes, then this should only again take 10 to 15 minutes, have somebody timing you. It's amazing how much time goes when you are concentrating hard on something and you just have to be aware that every minute counts, particularly if that foetus is still alive.
If the foetus isn't alive, that does give you a little bit more decision making, but certainly again for mare health, again, you need to be aware that the longer things are ongoing, then the more likelihood of other problems are occurring. If the mare's straining excessively, obviously sedation, we've already mentioned, you can place an epidural and administration of clambuterol can assist with by providing uterine relaxation. OK, so if your foal cannot be delivered that way and you think, you know, a vaginal delivery is still possible, you may have something like a transverse presentation, which is very, very difficult to deal with, where you may be deciding to go straight into a caesarean section, if, this is something that is being done within a hospital situation.
But I think the difficulty is when you're having to make a decision, do you go for this on the farm? Because obviously, you need to be able to ideally hoist the mare's limbs up, up to even a sort of a 60 degree sort of angle of the mare's body, just to give you that extra room. But obviously you've got a mare that's anaesthetized.
So if you're doing this on the farm and you still can't get the foetus out, the reality is if that foetus was alive at the time, by the time you wake the mare up and get it transported to a surgical facility, the chances of that foetus being alive. Or being viable are greatly reduced. So these are all decisions that can only really be made for that individual case, and in some situations, depending on your geographic location, you may have no option other than to deal with it on the farm.
So your controlled vaginal delivery would be where the mare's anaesthetized, and the limbs are elevated and you're still aiming to get the foetus out of her vagina. In a clinic situation, you can see that we've got an assistant, we've got everything being prepared for a caesarean sections that the mayor's midline is being clipped so that we can proceed straight to a caesarean section if within, you know, 5, 10 minutes, we still cannot get that, that fallout or think it's unlikely that we're gonna get that fallout per vagina. OK, so coming on to caesarean section again, this will be something that you're all very aware of in, in, the horse and other species, and, there's little sort of basic difference other than, obviously the sooner that this is done, the better, particularly if you're going to get a a live fallout, the, the more quickly it should be performed.
Said compared to other species, relative foetal oversize is very uncommon, in mares, and it's usually due to, posture and presentation that are not correctable. I'm not gonna run through caesarean section in a huge amount of detail. It's nicely described in surgical textbooks.
But the key thing is that if it's going to be performed, it should be performed quickly. Even if the foal is dead, it might still be the best option for, saving that, mare. Just some other options.
Obviously, you may be in a situation where you're unable to actually do anything to, you know, do a, a traditional caesarean section on the farm. So you may elect for a terminal caesarean section, where the foal is more important than saving, the mare, might be chronic disease in the mayor. So, you deliver the fall under anaesthesia.
Obviously you wouldn't want to euthanize the mayor first because that's before delivering the foal, because that's going to very quickly euthanize the foal as well. So you did anaesthetize the mare, deliver the foal, and then euthanize her. I suppose one thing just to sort of mention just coming back to caesarean section is obviously our traditional sort of in the Western world doing this under general anaesthesia and dorsal recumbency, but particularly with donkeys, there are reports of doing standing, a caesarean sections through a flank incision.
So I guess if you don't have the sort of the traditional options, kind of anything goes and you've got all the options and to weigh up depending on your expertise and what the owner wants to do. Just a quick note with regards to caesarean sections in in the owners will then have the implications of rearing an or an orphan foal if you're doing a terminal caesarean section. You may have the ability to organise a foster mare, but remember, a hand rearing orphan foals has its challenges, in many ways, time and also behavioural issues.
And then just to mention phytotomies or embryotomies again, very similar principles to other species. And but be aware that these can cause considerable trauma and that it's something not to be undertaken lightly if it's a, a technique you've not really done before, or in those cases where the dystopia can't be easily easily resolved with just a few cuts. And again, there are lots of surgical textbooks, describing techniques for, for doing this.
OK, so coming on to immediate postpartum complications, you need to be able to assess and and monitor the mayor, or get the owner to assess and monitor the work may after falling. And again, that's where experienced stud staff will know those things that are normal, those that, you know, where, veterinary assistance is required immediately. And really just making sure that you monitor just in the same way that you would do with any species because things can obviously do happen quite rapidly, either with your newborn foal or with the mare.
So observing for the normal expected behaviour of both the mare and foal in those first few hours, the normal passage of the foetal membranes and assessing them to check to see whether any portions of the foetal membranes. Remain, by inspecting, what's passed. And I'm not gonna go into lots of detail about retained foetal membranes, because that's all very nicely described, for managing them.
But making sure that, if they're retained any longer than the expected sort of normal passage of 2 to 4 hours that you are going in there proactively to manage them, and particularly in certain breeds of mass, such as your draught breeds who are very susceptible to the subsequent, endometritis that occurs. And obviously, there will always be some trauma that occurs and the reproductive tracts, particularly the vagina and vestibule and the vulva following part tuition, but just to identify those where more severe trauma occurred. And some lacerations, for example, your 1st and 2nd.
Degree lacerations are very amenable to repair immediately following part tuition, whereas those more involved ones such as your 3rd degree lacerations, and then obviously what you'd normally do is wait to perform repair of those once all the inflammation and infection in those tissues has been resolved. So colic signs, I'll put them into sort of things that you might see and what might actually alert you to problems. So colic signs would be those things that you would worry about in your mare.
obviously during during pregnancy, as I've already mentioned, particularly the last tri trimester of pregnancy, uterine torsion would A consider consideration, but in those ones, in the early, the first few hours following potuition, and the key ones would be postpartum haemorrhage, slightly more delayed ones were if a fall during delivery is managed to cause tension of the meen tree, causing tearing, for example, things like segmental necrosis of the small colon. Or if there's a tiny little hole in the uterus, it may take a number of hours for the mare to start showing signs that she's developing a peritonitis. After those sort of initial first few hours, that first couple of days, then the latest sort of postpartum in your first few weeks postpartum you get might get things like gastrointestinal signs of colic, your large colon vulvulus and, and other lesions that can occur.
So all very sort of classics, no different to your usual sort of investigation of a colic case, and obviously what you're going to be able to do in the field is going to be a little bit dependent on what facilities, what equipment you've and expertise that you have. So, just looking at excessive straining, things that you might be dealing with, would be usually pretend foetal membranes, but other sort of causes might involve a lot of soft tissue trauma. The problem is, is that if a mare strains excessively, then that ongoing straining may result in prolapse of one of a number of structures.
So your classic one being as on the right here, uterine prolapse, or you may get rectal, sorry, on the right of the screen, on the far left of the screen, you might get rectal prolapse and in the middle here, bladder prolapse. So, the bottom line is if a mayor is straining a lot, you need to find out what's happening, and you may, obviously need to deal with the secondary consequences of this, as well as trying to work out what the inciting cause was. So the most life threatening and probably most common of all of these is that immediate postpartum haemorrhage.
These are classically rupture of the middle uterine artery, which occurs in older mares who've had multiple falls and obviously, when an artery ruptures, unless, haemorrhage is control controlled usually within the broad ligament, of the uterus, free uncontrolled haemorrhage into the abdominal cavity, is going to be potentially, fatal. So the key issues with these are to minimise stress to the mayor, so you're not taking the foal away, you're not doing anything to really get the mayor's, blood pressure up. You want to keep this mare quiet in a dark and stable with minimal disturbance.
Obviously, in terms of veterinary assessments, you're going to want, want to make sure that you're happy with your diagnosis. The most sort of classic thing is for people to sort of panic a little bit and think, oh gosh, you know, the mayor's got a large colon and vulvulus, but forgetting that, you know, a large viscous, in the caudal abdomen could very well be a very large hematoma. And that's where, abdominal ultrasound, you could do this transrectally as well.
You can see that classic sort of smoky sort of grey swirling, . blood within, the, either the abdomen or within, the broad ligament, then that can help you with your diagnosis. With these mares, analgesia, obviously, like flunixin will help control that pain.
Obviously, she is bleeding into the broad ligament, that's going to be painful. And low dose sedation, obviously, you don't want to necessarily administer high doses because that may alter the mayor's blood pressure but keeping her comfortable, and trying to minimise the sort of the, the changes in blood pressure that go on. There's actually quite an interesting critically appraised topic, which is on early view and equine education, that Pam Wilkins has done, looking at the evidence for what is the best to treat mayors with postpartum haemorrhage.
And the reality is there aren't an awful lot of studies out there, they're quite biassed towards mayors who've made it into. A referral centre and obviously if they've survived that journey, they're probably going to be contained haemorrhage. But there's no obvious one sort of treatment.
So you can go in with minimal volume of fluids, just to treat any hemorrhagic shock. You obviously don't want to be going in and again, raising the blood pressure. And by giving an overload of fluids, and there are some other therapies such as tranexenic acids, that, that you can use.
But the bottom line is probably the most important thing is to try and keep that stress and avoid transporting that mare and getting her blood pressure up and treating as conservatively as as possible. Uterine torsion, I've already mentioned, it's pretty uncommon, but usually causes sort of low grades, and colic signs usually in that sort of late stage of pregnancy, but can occur during parttuition itself, and you can try and sort of rotate and the fall and correct that torsion at that time if the cervix is open. In, mares classically developing this in late pregnancy, then it may be that laparotomy under a general anaesthetic or via a flank laparotomy is performed.
There are some conservative approaches described where you anaesthetize the air and using sort of planks, etc. But that runs the risk of rupture of the uterus and wouldn't be my preferred technique. And again, it's just mainly sort of running through recognising this as a potential complication and techniques for performing sort of laparotomy and correction of these that are described in surgical texts.
So that's a little bit of a, a rattle through the mayor. It's a quite a big sort of topic to consider, but it's just making sure that you are aware of all the sort of classic things that may occur and the sort of the, the main sort of do's and and do nots to, to do in those situations. So just coming on to the second part, just running through emergencies that may occur in, in relation to the male.
I'd say most of these are related to castration, which obviously is a very important thing to cover because it's the most common surgical procedure that will be performed, probably in a field situation. But obviously trauma, might be quite important, particularly relating to breeding. but also a trauma relating to surgery, which I'll just come into a little bit.
And then there are a couple of other, little, penile and propecial issues that, might be related to sedation and general debility, which are important for you to be aware of the sort of the first aid measures with, with those. So I thought to present again in some of the sort of presenting signs of these rather than the diagnosis per se. And something that may well be, you might be called out to is an emergency is signs of scrotal swelling, particularly if they're accompanied by signs of colic.
So there are quite a few differentials for just scrotal swelling, of its own accord, but where you've got colic signs as well, then certainly inguinal herniation would be top on the list. And often I do find that people, immediately think that testicular torsion or perhaps more correctly termed torsion of the spermatic cord has occurred. That's actually very, very rare and it's much more likely that you've got, an inguinal hernia.
But, it can occur, and I'll, briefly, sort of run through that in a minute. Herniation through a rent in the vaginal tunic, I found a single case report of that. Again, you're always gonna get your weird and wonderful, but certainly scrotal swelling, signs of colic in, a stallion, inguinal herniation of usually small intestine would be top of the list.
So again, standard clinical examination as for signs of colic, and this is where your rectal examination is also going to come in very important for that sort of classic evidence of intestine entering the inguinal canal. Ultrasound examination, you could do per rectum as well, but ultrasound examination of the scrotum is where, ultrasound really comes into its, sort of own accord. And the great thing is that a horse has got two testicles, and then you can examine the sort of normal sides, as a sort of a comparison just to see what's going on.
And in horses with inguinal herniation, you may well see loops of small intestine sitting there, increased fluids around the, around the surgical, around the, the actual testicle. With torsion of the spermatic cords going a little bit more difficult and probably much more subtle, obviously, you might have, ultrasound machines where you're able to look at flow and Doppler, but out in the field, you may not have that, capability. So looking for sort of any swelling, and, swelling of the actual, testicle itself.
But as I said, torsion of the spermatic cord is, is pretty uncommon. So obviously the options are going to be different depending on the situation that you're dealing with, but most cases of inguinal herniation would need to be corrected under a general anaesthetic. I'm not going to run into the more conservative approaches for these a little bit beyond .
The remit of this, it's a, it's a lecture in itself, but, most cases of, inguinal herniation, where the, intestines become well and truly wedged in place would normally require a laparotomy under general anaesthesia to, free that trapped intestine. OK, so running on to castration complications, which is something very common following castration, and I'm sure those of you, who've done a number of castrations will have probably seen a fair number of these. The important thing to consider is prior factors that might actually make the likelihood of castration complications and more likely to occur.
So for example, a foal that had a scrotal or a horse that had a scrotal hernia. As a whole, would be certainly at increased risk of evisceration and following castration. So you're going to need to make sure that your castration technique utilises some way of actually ligating that vaginal tunic.
Obviously the technique that you use, whether you do, an open closed and whether you ligate, the vaginal tunic, will impact upon some of the complications. And obviously, if during castration itself, something abnormal, has, taken place. So the pre-castration check is really important, so it's the best way to try and stave off some potential complications.
Your signalments, there might be certain types of breeds, that might be, might have potentially wider inguinal canals or rings where you might have more likelihood of evisceration. I've already mentioned about scrotal or inguinal hernias, and obviously just checking that you've got two normally descended testicles, rather than anaesthetizing that horse and then suddenly finding that you've only got one testicle there, and that can lead to a whole host of other stresses, particularly out in the field when that's not what you're expecting to find. So, as with any surgical procedure, make sure that you know your anatomy and understand why certain complications may be more likely to occur.
And certainly with relation to castration, the most important factor with regards to complications is this vaginal tunic. And the state of it at the end of your castration process. Because remember, the abdominal cavity, there's that communication, this is peritoneal fluid that you see here, and that's why horses can eviscerate intestine.
And obviously, being aware of that potential crypto kit where you've got a retained abdominal testicle, which is obviously going to make your, what you thought was a routine standing bilateral castration, anything but simple. OK, so haemorrhage would be one of the most common complications that would occur following castration. So first thing you're going to do when you assess that horse, and obviously you're going to make sure that horse owners are aware of the signs to look for.
So the bit of dripping of blood, the first few hours after castration is not going to be a particular note. But if there is a steady stream, classically where you can't count the drops, they need to call you out. Or importantly, where dripping is ongoing for a number of hours, certainly I'd say more than 4 hours, then you need to go out and take a look.
So the first thing to do is assess the horse's heart rate. That's going to give you the best idea of whether a horse is in hemorrhagic shock. And also the horse's surroundings will give you a guide if there's blood everywhere or whether there's just a little bit of blood just on the horse's leg.
But, a heart rate of, sort of less than 40, you're not going to be too worried about hemorrhagic shock, whereas if your horse is standing there looking fairly settled or quiet, but has a heart rate of 60, then, you are going to be much more worried as to how much blood this horse has lost. So depending on the horse, you may need to do this all under sedation. You can try to clamp the vessel with curved artery forceps in the standing horse where obviously your, your, sort of, pedicle where it's been like, emasculated, maybe quite high up in the guinal canal and may be impossible to get.
You can try that, but often it's not successful. And that's where packing the scrotum. Then it's, it would be your next option.
It would be successful in most cases. Key thing is to make sure that you be as clean and hygienic as you can, and don't use cotton wool or sterile gauze swabs. I usually use just a straightforward sterile knit fix band.
That you can tie the ends together if you need more than one of these in place, and just pack it into the scrotum, you can fix it in place with just like a towel clamp and put through the scrotum as a temporary measure or you can put a suture in, and leave this in place for 24 to 48 hours. There's the odd case, it's not very common, but there would be the odd case where you get continued haemorrhage, or where the, testicular artery is sort of pinged back into the abdomen and is haemorrhaging into the abdomen. And, and those cases where you've got ongoing either obvious haemorrhage or a horse that's becoming progressively more tachycardic, that's where, surgical exploration, would be important and obviously, replacement fluid therapy.
Evisceration, obviously time is off the key. Owner should be appraised of looking for any any tissue that's hanging from the scrotum, and these are emergencies. And obviously, you may or may not have the surgical facilities close by to be able to deal with it.
These may be situations where if surgery is not an option, that Euthanasia has to be performed, but where surgical correction is an option, just checking to see what sort of systemic status the horse is in, getting the intestine lavaged. It's not always particularly easy to prevent further intestinal trauma and prolapse and in general, the quicker you can get a horse to a surgical facility. The better, and, obviously discuss with them any first aid measures, they would like you to take.
And, you know, these can look fairly horrific, but, you know, are perfectly survivable again, depending on the, you know, the duration and things have been going on, how sick the horse is and, and what needs to be done. But other prolapse of other tissue, wouldn't necessarily be as imminently life threatening. So prolapse of fascia or omentum would perhaps be more common.
So in these cases, you're gonna sedate the horse, give the exposed tissues a clean, you want to be as sort of hygienic as possible and resect back to normal tissue, with either sterile scissors, or you can re-easculate them. Rarely would a general anaesthetic be indicated to deal with these cases unless the horse is particularly fractious. And that worry always is about what to do with the other side, whether, you know, then they're more likely to herniate intestine through the other inguinal ring.
And in general, I would say, . To treat those horses fairly conservatively, keep them, sort of quiet, the risk is during those first few days, but in a high value horse, obviously, an owner might be quite keen to, negate that risk by having the vaginal tunics, closed. So some other complications that might occur again, I'm not going to go into these in a huge amount of detail, that wouldn't necessarily all be life threatening immediately, particularly the more chronic ones, and obviously anaesthesia rate related complications there are completely sort of different topic in itself.
. But making sure again that you've got things like tetanus cover. But where problems can occur is if you get very severe scrotal swelling, which can cause parahimosis, which is what we're going to cover next, or whether you potentially get a, ascending infection causing peritonitis, which in my experience is, is really pretty rare. So for the last sort of bit of this talk, I'm just going to concentrate on the the penis and the prep use, and, and just run through some of these conditions, which so there's quite a, a very nice article, and in practise a little bit old now, but actually I think it still, stands the test of time.
I think it is a very readable, very nice article that goes through all the potential, problems. So I would recommend that as sort of further reading, and I'll give you some additional readings at the end. So penile trauma would be pretty uncommon, certainly in your geldings, but would be more common in your cults and stallions, and particularly, for example, a, a breeding related injury where the mare kicks the stallion, during the, process and, can get quite marked, trauma, obviously, fractured penis, and where really quite marked trauma occurs is, obviously a, a pretty difficult situation which might necessitate, surgical intervention.
But a lot of them would be related to, either, lacerations, those in cults that have got a little bit excited when the mayor's gone past and tried to climb over stable doors, or where you just get a very big, hematoma, forming, and this is a, this is a cult that, had a, a massive hematoma developing within the, penile tissues. Just a quick mention about surgery and where it might be related to geldings if you are undertaking surgical procedures such as doing distallectomies or doing reefing procedures, do not undermine the local tissues because you can get really quite marked haemorrhage into those. And if you get haemorrhage into those bits of integument, you can get some pretty huge hematomas which can cause big problems with parahimosis.
And make sure that you have good awareness of your local anatomy as well. So, penile trauma, you may have a situation where there's been blunt trauma, obviously a laceration, you may require surgical repair, and again, a paper that's just gone on to Early view in equine veterinary education, little bit, you sort of think, oh, goodness me, how can that occur, but I can see. If you weren't sure of your anatomy or where you're going hunting for a retained testicle, and what you don't want to be doing is, as described in this case report, is putting a set of emasculators around the base of the horse's penis.
That is going to be a little bit of a surgical challenge to try and fix. So, . With any penile trauma where there's been laceration of those tissues, the critical thing is obviously to check the viability of those penile tissues.
I remember the large arteries lie dorsally, artery and vein, but also making sure that the urethra is intact, because if not, you may need to undertake surgical repair or in the worst case situations with a horrific trauma such as emasculating the base of the horse's penis, you may have to, amputate the the penis itself. But for most of these cases, just ice packs, cold hosing, nonsteroidals and antimicrobials, and providing some sort of degree of support to the penis would be important. I'm gonna run just through that in the next few slides.
Pri is and I'm just going to very briefly mention this is where you get persistent penile erection without sexual stimulation and is a dire emergency if the horse is going to be maintained as a breeding stallion. It's usually related to ACE chromazine, but can occasionally occur with any of the alpha 2 agonists. But, it's actually pretty uncommon.
There was a survey done a few years ago where actually very, very few vets had encountered. Those problems, fortunately. But when they do occur, it would be an emergency, particularly within a breeding stallion, where you do need to act quickly, to try and reduce that swelling.
And I remember these horses can't urinate, so making sure that they don't develop urinary rupture by passing a catheter. My computer spell check and misspelt that, so it's benzatrine, benztropine meth methylates therapy can't even say it. That needs to be given pretty quickly and again, that's sort of well described in some of the textbooks and the surgery may be required, in certain situations.
Paramosis would be something that is pretty common, and is an emergency within horses and this is where you get persistent penile protrusion, and it could be related to any form of sort of swelling from a kick, some sort of trauma. The case that's shown at the top here is actually a horse with emaciation, which is severely hyperprotemic, which is just purely down to edoema. But quite quickly, this propecial ring forms a constricting cuff, and it cuts off the blood supply, so you get this horrible self-perpetuating cycle of edoema, and then, the penile and propecial tissues become traumatised and and infected.
And your end result may be permanent penile paralysis, as shown in the horse, the grey horse on the left here. So certainly a disaster with your breeding stallium but isn't ideal in in your geldings either. So what you need to do is identify the cause and sort of decompress the penis.
And so usually sort of sedating the horse, and, getting an elastic bandage on. This was a debilitated horse that was presented in recumbency, but you may have to do this in a standing horse and just getting the elastic bandage on just to try and squeeze some of those tissues out. And massage, non-steroidals, just trying to work that penis back into the prep use.
That's the most critical thing, because if you can maintain the penis within the prep use, that whole sort of vicious cycle won't develop. So once it's back in, you might want to put purse string sutures in or other means of support, but it's that initial, getting that, that penis back into that prep use. And, just some ways you may or may not be able to get that penis back in.
There are various sort of homemade sort of devices to try and maintain a penis within the prep use. But one that's easily accessible and I've found works really well for me, and for, for the cases that I've been dealing with is just to use a pair of tights, cheap, cheerful, people describe using lace from shops. Well, you can get a set of tights from, anywhere.
And it, it enables it sort of soft, they're cheap. You can throw them away after each use. The horse can urinate through them, and it just forms a sling that's able to just avoid that sort of gravity dependent edoema and trauma.
And so you're able to get emollient creams on just to keep any exposed, penile and propecial tissues nice and supported and keep them, moist and avoid that ongoing trauma. And my computer has managed to shrink all these down. I apologise for that, but hopefully you can, well, they're not, to be honest with you, that exciting.
The ones at the at the middle and bottom are a horse that presented with urethral obstruction due to a smegma beads, a very large smegma beads. But whilst per se, it's not really a Productive emergency, urethral obstruction and that rare case where you get a urolith as the one pictured that becomes lodged within the penile urethra can present as signs of colic. And so just to remember that that colic case, which just doesn't quite fit the textbooks, particularly if you've got slight penile.
Intrusion and dribbling of urine, you would certainly want to examine the penis and make sure that you can pass a urinary catheter. And if you've got an endoscope available, just the same as you would do with doing a normal upper upper airway examination if that's sort of a standard sort of 89 millimetre. Endoscope, you can pass it, with lots of los up the urethra and identify that obstruction there.
So not strictly a, a, a reproductive emergency, but certainly would be related to obstruction of the urethra within the penis and obviously requires surgical intervention. OK, so that's kind of a sort of a very broad overview of sort of the key reproductive emergencies that you might encounter and was really just to make sure that it gives you a sort of an overview of the critical things that you might need to sort of deal with. Obviously I haven't been able to provide, I go into lots and lots of details about these, but there are Some good textbooks out there that, go into a lot more detail about these, and how to manage them.
But the key thing is obviously just making sure that you obviously try to save the horse's life, maintain, reproductive function, and, that you're prepared for these potential scenarios when you go to see these horses in practise. All right, so I think I'm just about within time for any questions and I just wanted to say, thank you very much for taking the time to listen.