BY SABRINA BRASHARES / JUMP MEDIA
Colic is every horse owner’s worst nightmare, and when the patient is also pregnant, the emergency situation becomes an even bigger challenge for their owner and the team of veterinarians entrusted with their care. In late February of 2022, a pregnant mare named Willow was brought to Palm Beach Equine Clinic (PBEC) by her owner for colic. The team of PBEC veterinarians on this case included Dr. Justin McNaughten, DACT, Dr. Peter Heidmann, DACVIM, and Dr. Elizabeth Barrett, DACVS-LA.
When Willow arrived, she was showing signs of colic and had an elevated heart rate of 120 beats per minute. The veterinarians on her case immediately performed a nasogastric intubation in order to relieve excess gas, fluid, or a possible gastric impaction. Once her stomach was decompressed by the nasogastric intubation, the team continued with the colic workup to find the cause of Willow’s discomfort.
“Since Willow was in the later stage of pregnancy, the foal occupied the majority of the abdomen,” explained McNaughten. “Findings on rectal palpation and abdominal ultrasound were inconclusive. The working diagnosis was ileus or decreased gut motility, but the root cause was still unknown.”
Willow was fasted as the next part of her medical treatment. The team at PBEC started her on intravenous fluids with prokinetics, electrolytes, and dextrose as a source of nutrition for the foal. Although Willow stayed comfortable overnight, she continued to have small amounts of reflux.
The next morning, Willow was showing new signs of gas distention, which were not present when she first arrived at the clinic. An abdominocentesis was performed, which is the process of obtaining peritoneal fluid to assess intestinal damage. The abdominocentesis revealed that her peritoneal fluid values were elevated, which indicated that surgery might be needed.
Before deciding to perform the surgery, the PBEC team had to take into consideration that Willow was pregnant and determine the safest option for the unborn foal in addition to Willow.
“When we are dealing with pregnant mares, we often make decisions based on the stage of pregnancy,” said Dr. McNaughten. “The biggest obstacle is trying to treat the mare and doing what is safe for the foal in utero. For example, we may use different medications that are safe during one stage of pregnancy and not another, or delay procedures until after the mare delivers the foal.”
Since the breeding had occurred in a paddock, the owner did not have an ovulation date, which is a factor that could have been used to help determine whether or not surgery was the correct next step. The veterinarians decided to perform a diagnostic test to help determine if the foal was ready to be born or not. This test was done by evaluating the pH level of the mare’s mammary secretions.
Based on Willow’s need for colic surgery and the foal’s fetal readiness, the team at PBEC discussed their options and the risk factors for both the mare and foal.
“The owner was presented with the options of performing colic surgery with the foal still in utero or inducing parturition and performing colic surgery once she foaled,” commented Dr. McNaughten. “At the owner’s request, we induced foaling, which carries its own set of risks and can be life-threatening to both the mare and foal.”
In this case, the owner’s decision proved to be the right call. The filly was successfully delivered with no major or urgent concerns. Following the delivery, Willow was taken into surgery. During the colic surgery, Dr. Barrett was able to identify and remove a large fecalith, which is a hard concretion of ingested material that may increase in size and become a blockage in the gastrointestinal tract. This was determined to be the root of the problem, as it had the potential to obstruct the bowel.
While Willow was in surgery, the filly was examined. Although she was not showing external signs of prematurity, the veterinarians took radiographs of her knees and hocks as a precaution. The X-rays showed there was incomplete ossification of the cuboidal bones, which make up the knees and hocks. This meant that the filly was premature and would have to be monitored closely for a few days.
After surgery, Willow remained comfortable while still at the hospital. Since Willow did not have enough milk to sustain the foal at first, the veterinarians started the foal on prophylactic and antibiotics. She was also given milk initially through a feeding tube.
Approximately 48 hours after birth, the filly developed signs of neonatal maladjustment syndrome, which presents itself as neurologic abnormalities. One moment the foal was healthy, bright, and nursing, and the next, she was dull, listless, and disoriented. The team of veterinarians on the case noticed the change in behavior right away and were able to act quickly.
“The condition subsided following intravenous administration of neuroprotective agents and through the use of the Madigan foal squeeze technique,” commented McNaughten. “The Madigan squeeze technique is a physical compression procedure that involves wrapping a foal’s upper torso with loops of soft rope and applying pressure for 20 minutes, which replicates the compression a foal experiences during birth. This can help signal the foal to transition from sleeping in the womb to being awake after birth.”
After a few days, both Willow and her foal were discharged to the care of their owner and initially placed on stall rest. After stall rest, both had additional exercise restrictions to ensure that Willow’s abdominal incision properly healed and the filly’s cuboidal bones fully matured. When the veterinarians from PBEC checked in on them after one month, they were pleased to see that both Willow and her foal were happy and healthy.