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. Birmingham, 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, Newmarket. 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.


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