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WARNING

BELLS


Early detection of foaling problems




Supplied by Cameron Collins
BVSc MACVSc MRCVS
Equine Veterinarians Australia



Early recognition of problem signs during a mare's pregnancy, during the birthing process and in the first hours of a foal's life can be the difference between a life or death outcome.

Each foaling season, a number of newborn foals of all breeds die or spend significant time in hospital due to neonatal illness. This is obviously not the end result breeders hope for, given that for the best part of a year, all possible care and attention has been lavished on the mare carrying what, in many cases, is a highly sentimental and/or financially valuable package. When everything goes to plan and a healthy foal is achieved, it’s a very uplifting experience however, when the opposite scenario occurs, it can be devastating for all involved.

Although veterinary expertise, in the form of monitoring the health of both the mare and foal throughout the pregnancy, birthing process and the first few days of a new life, is invaluable in identifying any potential problems, the breeder also has an important role to play in this process. Those experienced in the breeding industry can easily recognise the attributes of a pregnancy that is progressing normally, a birth that isn’t going to require human intervention, a healthy foal and the achievement of crucial early milestones like the passing of the placenta and commencement of suckling within a certain time frame. These observations are certainly helpful ones for all breeders to be aware of, as it is reassuring to know exactly what will be happening, so when everything seems to be progressing ‘by the book’, the whole experience becomes much more enjoyable, exciting and satisfying.

In addition to the ability to identify factors that indicate the foaling process is going well, however, it can be of great assistance to a vet if a breeder is also able to recognise signs that all may not be right at the earliest possible stage. This means that issues of concern may be able to be addressed from a number of different angles, rather than the situation reaching a crisis point that leaves no option but for emergency measures to be applied. Even if a breeder notices what they perceive to be a worrying sign and seeks assistance straight away - only to find that it didn’t turn out to be a problem after all, that’s still a much better scenario (albeit usually a more expensive one involving a call-out at a very uncivilised hour!) than not noticing something until it’s too late.

Prior To Birth
One of the earliest warning signs that breeders can be instrumental in picking up is an abnormal pregnancy length (gestation), which may mean that a foal will be born either prematurely or after a longer period that is considered normal (320 – 365 days, with an average of around 341 days). Careful documentation by the mare owner of the last breeding dates, along with the results of pregnancy testing or an ultrasound if available, should enable a close watch to be kept from approximately the 300 day mark for signs of labour commencing. Alarm bells should start ringing for the breeder if a mare appears to be going into labour before 300 days of her pregnancy has elapsed, as most foals born this premature don’t survive - even with intensive care.

When a foal’s arrival seems imminent between the 300-320 day gestation period or it still hasn’t made an appearance after 360 days, the most practical action a breeder can take is to prepare for the possibility of caring for a newborn that is likely to have under-developed vital organs and physical deficits such as muscular weakness; dropped fetlocks (flexor tendon laxity); knee and hock deviations; a low birth weight; a short, silky hair coat and soft, floppy ears. A suitable area, that provides warmth, protection from the possibility of infection and is free from factors that may contribute to either the mare or foal being injured, needs to be set up in advance. This allows the foal to be placed in an ideal environment without delay, providing the practitioners and other people involved with its care with conditions to complement the work being done to increase its chances of survival.

Newborn foals and especially premature or dysmature foals are not able to control their body temperature, it is therefore vital that these foals are brought into a clean, warm, dry stable with new bedding immediately after they are born. Any time spent by a wet newborn lying in a cold, wet paddock or in the breeze can severely drop the body temperature and compromise the foal. These foals should be dried vigorously with towels and covered with reflective or woolen blankets. If the weather is very cold it may be necessary to build a wall around the foal with hay bales and put a fan heater in with the foal, care should be taken to avoid the possibility of fire and the heater should not be aimed directly at the foal.

Aside from observations related to the onset of labour, other indications of potential problems prior to foaling include a cloudy (white to yellow or brown) discharge from the mare’s vulva and milk dripping or running from the teats. These signs usually indicate infection and inflammation of the placenta (placentitis) and the likelihood of a premature, late or septic (infected) foal. If noticed early enough by the breeder, there are measures that can be tried to curb the spread of infection and address the inflamed placenta.

These will depend on the findings of a physical and an ultrasound examination and may include antibiotics to combat infection, anti-inflammatory drugs and an oral progesterone supplement to prevent the premature uterine contractions. These treatments may be effective if instituted early, that is when the mare first starts running milk or a vaginal discharge is noticed, however once active labour has begun nothing can stop the process.

During The Birth
Once the first stages of labour commence - during which contractions start and the foal moves from its back into the normal foaling position of the front hooves first (facing downwards), followed by the head between the front legs - there are a number of early problem signs that the breeder can watch for. These include severe, colic-type behaviour of the mare, as opposed to general restlessness, frequent urination and some degree of sweating - all of which are normal. If, however, the mare appears to be in severe pain with violent thrashing or pawing or getting down and up rapidly without making any obvious progress toward delivering the foal, this can indicate twisting (torsion) of the uterus or intestine or a uterine haemorrhage. These are serious conditions requiring urgent veterinary treatment so, the earlier they are detected, the better.

While waiting for the vet to arrive the breeder should attempt to stop the mare rolling and injuring herself, this is usually best accomplished by taking the mare to an empty grass yard or paddock and keeping her walking.

Most breeders would be aware that the initial stages of a normal labour - that is, the amount of time until the ‘waters’ break - can be as little as 20 minutes or as long as several hours, depending on the mare, so there is usually no cause for concern provided there is not any obvious signs of intense pain and distress as would be associated with bleeding or twisting of the uterus. What is important for breeders to note, however, is what the fluid released when the placenta breaks smells and looks like. If cloudy in appearance with a ‘rotten’ smell, this means it’s time to call for veterinary assistance - as it may mean that the placenta and the foal are infected.

Septic foals require immediate treatment with antibiotics and usually hospitalization with intensive care nursing, intravenous fluids and at times, intravenous nutrition. In spite of all that is done, a number of these foals are so compromised that they do not survive.

If a birth is progressing normally, a breeder would generally be expecting to see some evidence of the waters breaking and the tips of both front hooves starting to emerge together after a maximum of 2-3 hours - any longer being a possible indication of abnormal positioning of the foal. It is also important to be able to recognise the appearance of a healthy amniotic sac (the ‘bag’ enclosing the foal) as, if this membrane appears to be more like red velvet than white or translucent when it first becomes visible, there can’t be any further delay in seeking veterinary assistance. This condition, known as ‘red bag presentation’, results in the unborn foal being deprived of oxygen, so the faulty membrane must be ruptured and the foal delivered as a matter of urgency.

While waiting for the vet to arrive, those studs with oxygen on hand could administer this by inserting the flexible administration tube about five to seven centimeters up the foal’s nose and run it at a rate of ten litres per minute.

After The Birth
Once a foal has arrived, if all the observations made by its breeder so far have not indicated any potential problems, it isn’t time to relax just yet - as there are many both subtle and more obvious signs of abnormal behaviour or appearance to look for in the newborn. Some of these relate to specific conditions with a defined set of symptoms such as Lavendar Foal Syndrome, Neonatal Isoerythrolysis (NI) and Jaundice, while other, more general terms such as Hypoxic-Ischaemic Syndrome (HIS) or Neonatal Maladjustment Syndrome (NMS) refer to the consequences of a foal being deprived of oxygen either in the uterus or during birth. The latter are sometimes referred to as ‘dummy foals’ and typically have difficulty standing or suckling, or may show a variety of behaviours such as wandering from the mare, pressing their head into the corner of a yard or box, attempting to suck walls or posts, making abnormal vocalisations like a ‘barking’ noise (instead of whinnying or nickering) or convulsions.

If the pregnancy and foaling progressed without problems, the most important thing for the foal immediately after birth is that it stands and sucks the colostrum from the mare in the first twelve hours of life. Colostrum - the first milk the mare produces - contains the antibodies and compounds the foal needs to establish its immune system to fight infection. A foal can only absorb the colostrum for the first twelve to eighteen hours after birth. So if it cannot or does not suck or if the mare does not produce good quality colostrum or if the collostrum was lost because the mare ran milk prior to foaling then the foal will have no defence against infection and will require an intravenous plasma transfusion. The best thing a breeder can do for any newborn foal is to have their veterinarian take a blood sample for an IgG test. This test is very straightforward and measures the level of antibodies circulating in the bloodstream.

There are also a wealth of signs a breeder can pick up on in the first few days of a foal’s life - many of which can become serious if not noticed and treated, but respond well to prompt attention. The most common include colic-type behaviour - such as the foal rising and lying down frequently, rolling, lying on its back, straining to pass faeces or urine - all of which can result from feeding irregularities (too much or too little milk), retention of the meconium or impending diarrhoea.

Urine dribbling from the umbilicus (patent urachus - the stump left after the rupture of the umbilical cord) can often indicate the presence of a bacterial infection, while milk staining a foal’s face is often caused by it standing under the mare’s udder, but not drinking - a behaviour that is frequently an indication of discomfort, HIS or impending illness.

Diarrhoea, whether caused by a bacterial infection or another factor, is also a worrying sign that is vital for breeders not to miss as the dehydration associated with it can result in rapid deterioration. Accompanying diarrhoea and dehydration can be a state known as entropian, which can be detected by closely examining the foal’s eyelids to see if the loose skin on them is tending to turn in so the hair touches the cornea (eyeball surface).

Yellowing of the foal’s lips and gums, if noticed by the breeder after it has commenced suckling, is usually seen as a consequence of the antibodies from the colostrums in the mare’s milk causing destruction of the foal’s red blood cells - this life-threatening situation requiring urgent veterinary attention in the form of intravenous fluids and/or blood transfusions .

When it comes to foals, early recognition of potential problems by a breeder with astute powers of observation, combined with the experience and skills of a veterinarian in being able to diagnose and treat a foaling issue promptly, are the keys to achieving the best possible outcome.

THE NORMAL FOAL AND FOALING PROCESS
The following is a summary of what are considered to be normal experiences for a mare and her foal to have prior to the birth, during the foaling process and afterwards;

The normal gestation (pregnancy length) for a mare is 320 – 365 days, with an average of around 341 days.

Signs of impending foaling include relaxation and slight swelling of the mare’s vulva; occasionally small amounts of clear mucus discharge; relaxation of the pelvic ligaments to create a sunken appearance of the muscles on either side of the tail head; enlargement of the udder and ‘waxing up’ (the production of white/yellow colostrum secretion which collects on the ends of the teats). These signs can occur between two weeks and 24 hours prior to foaling but some mares, especially maidens, may foal without showing any.

A mare’s labour is divided into three stages.

The first stage involves the commencement of contractions of the uterus and movement of the foal from lying on its back with its legs curled up to lying in position for delivery - this being on its sternum (breastbone) with its head between its outstretched front legs. This stage ends when the placental membranes rupture and the mare ‘breaks water’, releasing a quantity of straw coloured, urine-like fluid.

Stage Two of labour consists of the powerful, active contractions the mare makes to deliver the foal, usually performed while lying on her side. These contractions occur in groups of three or four, followed by periods of two to three minutes rest - during which the mare may rise then lie down again. The white/translucent amniotic sac should appear at the vulva within five minutes of the water breaking, and one or two hooves with the soles facing downward should be visible within it. As the contractions continue, the front legs are presented, usually one slightly in front of the other, then the head with the chin resting on or between the knees. The amnion usually ruptures as the head and shoulders are delivered, however if it remains over the head and nostrils, it should be removed to prevent suffocation. The mare will often stop straining and rest once the foal’s hips are clear of the vulva but not usually for long, as the whole of Stage Two should only take about 20 minutes.

The final stage of the foaling process involves expulsion of the placenta, which should happen without obvious straining and within 30 minutes to three hours of the birth. Until it is passed, the placenta can be tied to itself in a ball to prevent the mare standing on it - thus tearing it before it is completely expelled - or becoming entangled. The placenta shouldn’t be cut off, as the weight of it hanging from the vulva assists its removal and, once completely free, should be collected for inspection by an experienced foaling attendant or a vet - who will determine if any intervention is required to remove part or all of the placental tissue from the mare.

Once the foal is delivered, the mare may stand immediately or may roll from side to side then sit up on her chest and remain quietly picking at grass, until movement and sounds from the foal stimulate her to rise.
Normal, healthy foals should be able to sit up and hold themselves on their chest within two to five minutes of birth, have a good sucking reflex within 20 to 30 minutes, be able to stand within two hours and be capable of nursing from the mare within two to four hours. Within twelve to eighteen hours after birth foals must receive colostrum, ‘first milk’, to provide antibodies to fight infection and glucose for nutrition and energy. Following nursing, they should pass the meconium (the hard, brown/yellow first faeces), urinate, lie down and sleep. Foals that are woken should be alert and curious, standing without hesitation and seeking the teat.

VITAL SIGNS
. Within five minutes of birth, the foal’s heart rate should be 80-120 beats per minute, respiration rate should be 30-40 breaths per minute and lips and gums should be pale pink. Rectal temperature should be between 37.2 and 38.6o Celsius, usually at the lower end of this range immediately after birth and rising slowly to plateau at about four days.

ABOUT THE AUTHOR
Cameron Collins
BVSc MACVSc MRCVS

Cameron graduated from the University of Queensland in 1991 and gained membership of the Australia College of Veterinary Scientists in Medicine of Horses in 1999. He is a partner in the Scone Veterinary Hospital and a member of the Equine Veterinarians Australia (EVA) Executive.

Scone Veterinary Hospital
Contact - http://www.sconevets.com.au/

About the E.V.A.
Equine Veterinarians Australia (EVA) is the professional body representing veterinarians who have a special interest in horses. Members of this group regularly practice in the area of equine medicine, supplying veterinary services and advice to horses and owners.
For more information Ph (02) 9431 5080, email: administration@eva.org.au or refer to the website www.eva.org.au


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