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  Discussion on Mare with retained placenta - Protocol Changes???
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Member:
judyhens

Posted on Monday, Apr 5, 2010 - 9:18 am:

We had a Haflinger mare retain her placenta 3 hours, 45 minutes last Thursday night. We gave her oxytocin when we were becoming concerned. The foal nursed vigorously and often. Everything I read defined retained placenta as 3 hours, so we gave her Banamine (which some articles suggested) several times after the placenta passed. We did nothing else, except watch her closely. Saturday night she had no vaginal discharge. Sunday after church she had a nasty vaginal discharge. We took the mare and foal to the vet. They flushed her yesterday, are reflushing her today, and possibly (if the discharge is still not clear) tomorrow. They have her on antibiotics and Banamine also I think. The one thing the vet said that we should not have done was give oxytocin. She said that it can actually cause the uterus to clamp down on the placenta, being counter productive and that the nursing releases the correct amount. This is contrary to what the clinic said even a year ago. Have you heard anything about a change in protocol re: oxytocin?
The mare has no fever and they expect a great outcome.

One possible mistake in your article re: Retained Placenta. Under treatment: "There will be some straining that frequently is followed by expulsion of the uterus." Should that be "placenta"?
Member:
stek

Posted on Monday, Apr 5, 2010 - 1:04 pm:

Interesting Judy. Did the placenta appear intact when it was examined after passing?

I have been out of the foaling business for a while but in the past our standard of care was to give 1 dose of oxytocin after 3 hours. I know from recent experience in humans an oxytocin is common after delivery, even if the baby is nursing well.

We would also tie up the placenta so the mare couldn't step on it and sometimes add a little weight by way of a quart bottle of water tied to it. Will be interested to hear the current recommendations.
Member:
judyhens

Posted on Monday, Apr 5, 2010 - 1:55 pm:

Yes, the placenta appeared to be intact. We tied the membranes up to about hock level as soon as the mare stood up. We were worried about a potential infection when she passed the 3 hour mark, so we took her to the vet immediately after seeing a discharge. Thankfully the clinic had vets available on Easter....

The change in oxytocin protocol was one thing the vet mentioned which deviated from what we did. Another was flushing following a retained placenta.

Thanks for your feedback and interest!
Blessings,
Judy
Moderator:
DrO

Posted on Monday, Apr 5, 2010 - 7:40 pm:

Hello Judy,
As our article indicates I have heard no such proclamation and examining PubMed see no such information newly published. Indeed as early as last year a research study was expounding on the virtues of oxytocin administration for retained placenta. I would be interested in any research they have that says otherwise.

Though standard treatment for many decades it is important to note there is little scientific support of the efficacy of this treatment for retained placenta. We still do not know if this helped you or was coincidental to your mares successful expulsion. On the other hand at 3 hours postpartum I would be giving oxytocin.

Could you describe your nasty discharge? A thick brownish postpartum discharge for several days following birth would be in the range of normal.
DrO
Member:
judyhens

Posted on Sunday, Apr 11, 2010 - 12:28 am:

Thanks for your response. Since we had been worrying about the possibility of an infection we had been checking her discharge about every twelve hours or so. She had very little discharge the first two days - nothing I would consider in the least worrisome. On the third day it became thick, profuse, and brown. It was such a deviation from what we had been seeing, that we took her in on Easter Sunday. The vet said that she was not running any temp, and her affect was perfect. However, the vet said the flush contained some really nasty stuff. I wonder if you flushed most mares 2.5 days out if it would contain pretty nasty stuff???? Anyway, it was the abrupt change in amount and consistency that prompted us to take her to the vet. Do you think this is common and perhaps we over-reacted? How can one best differentiate normal from beginning infection? We had one mare develop laminitis several years ago secondary to a retained placenta. She recovered. However, it has put us on edge...

I will ask the vet re: research documentation in her changed protocol. Doesn't make a lot of sense to me as I think about it....

Thanks again for your input. Useful as always!

Blessings,
Judy
Moderator:
DrO

Posted on Sunday, Apr 11, 2010 - 9:21 am:

I expect some amount of thick brown discharge postpartum Judy so unless I think it abnormal in some way I do not flush. A sudden increase in amount of discharge heavier than I would expect would lead me to flush the uterus with saline. The consequences of purulent uterine infections, primarily severe laminitis, are serious enough to aggressively prevent.
DrO
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