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Advice on Equine Dystocia
Dr Fiona M Lacey

Introduction
A dystocia is one of the few true emergencies in equine practice. Quick response time, a well organised foaling kit and mental preparedness can make the difference between life and death for the foal.

Normal
In order to be certain things are going wrong it is essential to know normal in all its variations.
  • Stage 1: Usually lasts 1-4 hours and may consist of
    • Restlessness, pacing, circling
    • Getting up and down frequently
    • Passing small amounts of manure or urine
    • Occasionally mild colic like symptoms

  • Stage 2: Begins when the chorioallantois ruptures (‘water breaks’)
    • Usually lasts 10-30 minutes
    • Most mares lay down at this point
    • Amniotic sac emerges as a whitish balloon
    • One foot presents first, with the second sitting behind it and the nose will begin to emerge by around mid cannon/knee
    • Front feet should be delivered with soles facing down
    • Some mares will get up and down, often rolling at this stage
    • Once shoulders are through the rest of the foal typically follows quickly
    • Stage 2 ends when the foal is delivered

  • Stage 3: The expulsion of the placenta
    • May take from 1 – 3 hours
    • Over 4 hours can be considered retained
    • Over 8 hours treatment required

Initial Assessment
It is important to quickly establish the presentation of the foal and assess the likelihood of a successful vaginal delivery. If the foal is alive but the positioning makes vaginal delivery unlikely owners need to quickly decide whether referral for a caesarean is an option or whether they would prefer to sacrifice the mare and perform a field caesarean to save the foal. If the foal is dead but the mare is valuable, a caesarean is still the best option in terms of future breeding soundness. Foetotamy usually results in significant damage to the reproductive tract, particularly the cervix, and a very poor prognosis for future breeding. Mares are not cows!

Types of Dystocias
  • Upside down – protect dorsal vaginal wall, confirm they are front feet (not back) and add some rotational pressure. Will correct easily.
  • One foot back – very common, typically easily corrected but may have a carpal contracture
  • Both feet back – not uncommon, can usually correct unless significant carpal contracture
  • Head back – can be very difficult with a live foal, easily corrected with a chin hook
  • Neck presentation – foal is often dead as owners fail to recognise foaling, usually deliverable
  • Backwards – emergency as pelvic compression will restrict umbilical blood supply, usually deliverable
  • Breech – a difficult presentation, consider caesarean and mare/foal relative value
  • ‘Dog Sitting’ – a very difficult presentation, consider caesarean and mare/foal relative value
  • Transverse Presentations – uncommon, usually require a caesarean

Post Foaling Care
Most foals that survive a dystocia will have some degree of compromise and many will require resuscitation or oxygen (if available) and possibly ongoing care. Owners should consider referral to a hospital experienced in neonatal care. Milking the mare and tubing the foal is worthwhile in either case and making a thorough assessment of the mare is important. Most mares that have undergone a dystocia will require antibiotics, NSAIDS and uterine lavage over the following days and it is also important to check that the placenta is passed in a timely fashion.

Conclusion
  • Consider sending your mare to a professional foaling down establishment
  • If you really want to foal your mare at home, get an alarm and make sure you are familiar with the foaling process.
  • Remember that once stage 2 has begun, the foal should be out in 30mins or less
  • If you have no sign of feet within 15-20 mins you should call your vet for advice
  • We DO NOT recommend travelling the mare to a clinic as a routine. A competent and experienced veterinarian will be able to correct well over 90% of dystocias in the field.
  • Mares which have been stressed by travel, foaling in a strange environment or worse, anaesthetised, are far more likely to have the maternal bonding process disrupted, which may be detrimental to the foal.
  • On the very rare occasion your mare may require hospitalisation a competent and experienced veterinarian will make that decision very quickly and can give the mare some medication prior to travelling.
  • In most cases an awful lot of money, time and emotional energy have gone into getting your mare to this stage – don’t risk it by not being prepared!
Foaling Kit
  • Torch
  • Tail Bandage
  • Bucket
  • Towels
  • Disinfectant (chlorhex, iodine)
  • Enema
  • Umbilical Clamp