Equis ISSN 2398-2977
Perineum: trauma
Synonym(s): Rectovaginal injuries
Contributor(s): Jean Pierre Held, Graham Munroe, Sarah Stoneham, Madeleine L H Campbell
Introduction
- Perineal injuries/lacerations are associated with parturition.
- Cause: dystocia (malpresentation or occasionally oversized fetus), extensive vigorous manual manipulation during foaling, violent expulsive efforts by the mare.
- Signs: dystocia; depending on degree of injury/tear one or both forefeet and/or head may be presented via rectum.
- Diagnosis: attempt to detect before perforation occurs.
- Treatment: repel foal and redirect limbs; repair severe lacerations after 4-6 weeks.
- Prognosis: depends on degree of injury; good after appropriate treatment.
Pathogenesis
Etiology
- Forefoot of foal catches on dorsal transverse fold of vestibulovaginal junction.
- Viable fetus may remove foot voluntarily → unimpeded delivery.
- Continued expulsion with no redirection of foot can drive foot and/or head through dorsum of vestibule and into rectum.
Predisposing factors
General
Specific
- Prominence of vaginovestibular sphincter and hymen remnants in primiparous mares.
Pathophysiology
- Foot of foal fails to pass vaginovestibular sphincter normally and is propelled caudodorsally.
- This may cause first, second or third degree perineal laceration, or a rectovaginal fistula.
- If presentation of foal not corrected can → third-degree perineal laceration.
- If second or third-degree lacerations not repaired → muscles will not heal and constrictor function of vulva will be lost → air and feces aspirated into vulva and vagina → chronic irritation, inflammation and infertility Uterus: endometritis - bacterial Vulva: Caslick operation.
- In rare cases laceration may extend into the abdominal cavity → peritonitis Abdomen: peritonitis → prolapsed intestines into vagina.
Timecourse
- Acute presentation during parturition.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Schumacher J, Schumacher J & Blanchard T (1992) Comparison of endometrium before and after repair of third-degree rectovestibular lacerations in mares. JAVMA 200 (9), 1336-1338 PubMed.
- Colbern G T, Aanes W A & Stashak T S (1985) Surgical management of perineal lacerations and rectovestibular fistulae in the mare - a retrospective study of 47 cases. JAVMA 186 (3), 265-269 PubMed.
Other sources of information
- Freeman D E (2014) Reproductive Tract Trauma. In: Proc BEVA Congress. UK. pp 72.
- McKinnon A O & Jalim S L (2011) Surgery of the Caudal Reproductive Tract. In: Equine Reproduction. Eds: McKinnon A O, Squires E L, Vaala W E & Varner D V. Blackwell Publishing Ltd. pp 2552-2557.
- Frazer G S (2004) How to Manage Acute Perineal Trauma in a Foaling Mare. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 228.
- Sutter W W, Hooper S & Embertson R M (2003) Diagnosis and Surgical Treatment of Uterine Lacerations in Mares (33 cases). In: Proc AAEP. pp 357-359.
- Held P & Blackford J (1997) Surgical Repair of Abnormalities of the Female Reproductive Organ. In: Current Therapy in Large Animal Theriogenology. Eds: Youngquist R S. pp 195-208.