Close this window to return to IVIS

www.ivis.org

Proceedings of the
10th International Congress of World
Equine Veterinary Association
Jan. 28 – Feb. 1, 2008 - Moscow, Russia

Next Congress:

Reprinted in IVIS with the permission of the Conference Organizers http://www.ivis.org/

Published in IVIS with the permission of the WEVA Close this window to return to IVIS

MANAGEMENT OF THE INFERTILE/SUBFERTILE MARE

Sidney Ricketts, Professor, LVO, BSc, BVSc, DESM, DipECEIM, FRCPath, FRCVS

Rossdale & Partners, Newmarket, UK.

The commercial horse breeder aims for a live foal every year from their brood mares. While
small family bands of feral horses and native ponies may sometimes achieve this, most
populations of commercial brood mares suffer conception and pregnancy failures which result in
some mares entering the next breeding season not pregnant, i.e. ‘barren’. Assuming normal
stallion fertility and adequate management, in most cases this is a matter of sporadic mare
subfertility, most commonly associated with obstetric injuries, uterine infections, age-related genital
tract disease or managerial problems. True infertility and epidemic subfertility, e.g. epidemic
venereal infections or viral pregnancy failures, are uncommon in mares.
It is the responsibility of the equine gynaecologist to:-
1. Maximise the reproductive health and efficiency of all mares under his/her care, so
that conception and pregnancy failures are kept to a minimum.
2. Specifically aid individual mares with reproductive problems to overcome or
compensate for their problems in order that they may conceive, undergo normal
pregnancy and produce a healthy live foal at normal term.
Fertility Expectations
Historically, it has been suggested that the equine species inherently achieves relatively low
fertility figures and that domestication makes matters worse. With good management, this is not
the case. Mare fertility results vary between populations. Data from the 2006 Weatherbys’
Statistical Review records that 653 registered Thoroughbred stallions at stud in UK and Ireland
mated 23,415 Thoroughbred mares. After excluding those mares for which no returns were made
and those that were exported or who died, the conception rate was 97.1%, the gestational failure
rate was 8.3%, the live foal rate was 88.8% and the barren mare rate was 11.1%. Therefore,
normally fertile and well-managed populations of Thoroughbred horses expect conception rates in
excess of 90% and live foal rates in excess of 80% and these are now the targets for both equine
studfarm clinicians and stud managers.
However, population statistics help little when considering aspirations for individual mares.
Weatherbys’ data demonstrates a linear decline in the fertility potential of mares with age with a
75% live foal rate for 4-year-old mares as compared to a 50% live foal rate for 20-year-old mares.
It is vital that clinicians, stud managers and owners understand that age has a major and
irrevocable limiting effect on a mare’s fertility potential.
By definition, an infertile mare is incapable of conceiving when mated by a fertile stallion and
is thus, by true definition, a sterile mare. The latter is uncommon for horses and is often
associated with congenital defects of the reproductive tract or gonadal dysgenesis, often
manifesting in demonstrable karyotype abnormality. In contrast, temporary breeding failures are
relatively common and these mares are more correctly termed subfertile. A barren mare is one
who is not pregnant at the end of the breeding season, for whatever reason.
Preparing barren mares for next season
In order to achieve maximal breeding efficiency, all barren mares should receive a thorough
examination after the end of the breeding season and before they go into winter anoestrus, e.g. in
September (northern hemisphere), with the aim of:-
1. Making a diagnosis of genital abnormality, if one is present.
2. Making a provisional breeding prognosis based on the abnormalities diagnosed.
3. Formulating and carrying out a logical treatment programme, if indicated.
4. Assessing the response to treatment after a period of rest.
5. Making a more accurate breeding prognosis based on the abnormalities
diagnosed and their response to treatment.
6. Repeating or substituting alternative treatment if their response to treatment is
unsatisfactory, until improvement occurs or retirement is recommended.
7. Allowing an extended period of rest before the next breeding season.

244
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

Without this preparation, mares may enter the next breeding season with persistent genital
abnormalities that then require diagnosis, treatment, re-assessment and recovery, delaying mating
and wasting valuable time.
The autumn barren mare examinations and treatments
An accurate diagnosis is, as always in veterinary medicine, a pre-requisite to prognosis,
treatment and successful management. This requires a detailed logical investigatory approach,
which, after taking a detailed reproductive history, may include a variety of tests to examine the
mare’s perineum, vulva, vagina, cervix, uterus and ovaries. Diagnoses are then made and specific
treatments are performed.
Reproductive history
The mare’s age and breeding history are vital pieces of information with which to start the
diagnostic process and are essential data with which to allow meaningful interpretations of
gynaecological abnormalities to be made. A young barren maiden mare (not pregnant after her
first season at stud with no history of conception) may be immature or even have gonadal
dysgenesis (e.g. X0 or XY sex reversal, manifesting with very small and persistently inactive
ovaries), whereas an 18 year-old mare who has produced 10 foals, suffered an early foetal death,
an abortion and two barren years, will not have gonadal dysgenesis but is most likely to have
chronic/progressive perineal conformational and/or uterine degenerative problems. A mare that
has failed to conceive or maintain a pregnancy following dystocia should be examined carefully for
cervical injury and/or incompetence.
Examination of the Vulva and Perineum
The conformation of the mare’s perineum and the integrity, shape and angle of slope of her
vulva, in relation to her anus is first evaluated, to determine if she is likely to suffer from
pneumovagina, i.e. she requires Caslick’s vulvoplasty surgery to be performed. Sometimes, small
fistulas are found in the vulval scar following previous surgery, and these need to be repaired. If
the mare’s perineal shape is very poor to the extent that Caslick’s operation is insufficient to
prevent pneumovagina, Pouret’s perineal reconstruction operation may be recommended. The
vulval lips are examined for signs of accidental injury, leading to incompetent closure. For
broodmares, all vulval injuries need careful repair and successful reconstruction to avoid
incompetent closure, leading to pneumovagina. The vulval lips should be manually separated
while the examiner pays attention to aspiration of air into the vagina. In mares with a dysfunctional
or weak vestibulo-vaginal fold, separation of the vulval lips creates a characteristic sound when air
is aspirated into the vagina. These mares, and those where the upper commissure of the vulva is
above the level of the pelvis, should be considered prone to pneumovagina.
In the UK, Ireland, France, Germany and Italy swabs are routinely collected from the
urethral opening, clitoral fossa and sinuses for annual screening for the potential equine venereal
disease organisms Taylorella equigenitalis, Klebsiella pneumoniae (capsule types 1, 2 and 5) and
Pseudomonas aeruginosa, as recommended by the Horserace Betting Levy Board’s (HBLB) Code
of Practice for the Control of Equine Venereal Diseases. These pathogens may exist in all of
these sites and, if found, constitute carrier status. Carrier mares are excluded from mating until
they have been successfully treated and proven so by repeated follow-up swabbing. T.
equigenitalis is sensitive to environmental conditions and swabs should be placed into Amies
charcoal transport medium immediately following collection to preserve the organism during
transportation to the diagnostic laboratory. The swabs should not be subjected to extremes of
temperature during transportation.
Vaginascopic (speculum) examination
The cervix and vagina are examined, via a sterile vaginascope (speculum), for their
appearance in relation to cyclic state (moist, pink and relaxed in oestrus, dry, pale and tight in
dioestrus), and for signs of injury, incompetence, discharge and/or vaginal urine pooling. Cervical
lacerations that impair normal function, particularly closure, always carry a poor prognosis for
future breeding. Some require attempts at surgical repair but such mares often remain ‘high risk’
for ascending placentitis, which often results in abortion or the birth of an impoverished foal. Other
cases heal sufficiently to allow functional closure without surgical interference. In such cases
some clinicians recommend that the mare is supplemented with oral progestagens (altrenogest), to
aid tight cervical closure, on empirical grounds.

245
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

If the mare is in oestrus, swabs are collected from the endometrium, through the open
cervix, via a sterile speculum for cytological screening for inflammation (the presence of
polymorphonuclear leucocytes, i.e. PMNs in a smear test), for the equine venereal disease
organisms T. equigenitalis, K. pneumoniae (capsule types 1, 2 and 5) and P. aeruginosa, and for
any of the multitude of opportunist pathogens (most commonly b-haemolytic streptococci, i.e.
Streptococcus zooepidemicus, Escherichia coli and Staphylococcus aureus and the anaerobe
Bacteroides fragilis). These opportunist organisms are only considered to be of significance, i.e.
causing endometritis, if there is cytological evidence of inflammation in the smear sample.
If the mare is not in oestrus, swab samples are taken from the endometrial biopsy sample
after it has been collected.
Rectal palpation and ultrasound scan examination
During oestrus, the uterus has minimal palpable tone and, especially in early oestrus,
endometrial oedema delineates the endometrial folds on scan examination. During dioestrus, the
normal uterus should have uniformly palpable tone and no palpable enlargements. Ventral
dilatations (areas of fold atrophy and myometrial stretching) may contain lumenal fluid
accumulations that may be either hypoechoic or hyperechoic on scan, the former indicating clear
fluid and the latter indicating haemorrhage or, more commonly, inflammatory fluids. In pyometra,
which is less commonly seen in mares than some other species, the uterus is uniformly enlarged,
palpably distended or ‘doughy’ and contains particulate fluid, giving a ‘scintillating’ hyperechoic
ultrasound scan appearance.
Equine ovaries are highly variable in size and activity depending on cyclic state. During
oestrus they may be large and contain follicles in varying stages of development, in addition to old,
non-functional corpora lutea. During dioestrus there will be at least one functional corpus luteum
in addition to follicles in varying stages of development. During anoestrus they will be small and
inactive, containing neither active follicles nor corpora lutea.
The most commonly diagnosed ovarian abnormality is the granulosa cell tumour. This
benign tumour causes one ovary to enlarge, sometimes enormously, and appear full of cysts on
scan examination, whilst the other ovary is characteristically inhibited and becomes small, hard
and inactive. Granulosa cell tumours are hormonally active and measuring the mares’ blood
hormone profile can support a clinical diagnosis. Diagnostic assays to detect granulosa cell
tumours include inhibin, testosterone, and progesterone. In a single blood sample of a mare with a
granulosa cell tumour, a-inhibin is elevated in approximately 90%, serum testosterone in
approximately 50%, and progesterone concentrations should be below 1 ng/ml since these mares
are not cycling. The cancerous ovary is removed surgically (often now via laparoscopic surgery),
allowing the inhibited ovary to regain normal function within 2-12 months. Other, much less
common ovarian tumours are cystadenomas, dysgerminomas, teratomas and malignant
adenocarcinomas.
True cystic ovarian disease is rarely confirmed in mares. Occasionally mares haemorrhage
excessively into an ovary after ovulation, causing enlargement and pain. A typical homogeneous
hyperechoic ultrasound scan appearance of the blood clot allows the diagnosis to be confirmed.
Most cases resolve with time but occasionally pain cannot be controlled without removing the
affected ovary surgically. Rarely, large ovarian haematomas are at risk of rupture, with fatal
peritoneal exsanguinations, so persistent or uncontrollably painful ovarian haematomas should be
treated by unilateral ovariectomy. Ovulation failure is a normal physiologic event for the mare
during the spring and autumn transition periods, but it may also occur occasionally in the cycling
mare. Persistent anovulatory follicles (PAF) are large (5-15 cm in diameter), and may result in
prolonged interovulatory intervals. The cause of ovulation failure is not fully understood, but has
been suggested to be endocrine in nature. PAF has been reported to occur in approximately 8.2%
of oestrous cycles, and the incidence was found to increase with age. PAF may contain blood,
which can be detected ultrasonically as scattered free-floating echogenic spots within the follicular
fluid. Eventually the haemorrhage will organize into echoic fibrous bands traversing the follicular
lumen. The majority of PAF develop into luteal tissue, which can be confirmed by elevated plasma
progesterone concentrations. Luteinised PAF can be treated with prostaglandins, and non-
luteinised PAF will regress spontaneously in 1-4 weeks. Pregnancy will not occur if the follicle
becomes hemorrhagic or luteinised without ovulating.

246
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

Endometrial biopsy
Special long (55 cm) basket-jawed forceps are essential to provide interpretable endometrial
biopsy specimens. Unfortunately, specimens obtained via endoscopic biopsy instruments are
inadequate for histopathological appraisal. Non-pregnancy must be confirmed prior to biopsy.
One biopsy taken from a mid-horn region is diagnostically representative unless there are palpable
uterine abnormalities, when more than one sample should be taken. A mid-dioestral biopsy is
recommended as a routine. The sample is retrieved carefully from the instrument with fine forceps
or a needle to avoid artefactual damage and then placed into fixative without delay. If the mare is
not in oestrus and a swab for bacteriological examination was not collected via the cervix then the
inside of the biopsy forceps should be swabbed immediately after removal of the tissue specimen.
On some occasions, additional tissue (usually an adjacent endometrial fold) is retrieved, not
required for fixation for histopathological examination and this can be used for bacteriological
examinations. Bouin’s fluid is preferred as histopathological fixative for reproductive tissues in
general and endometrial samples in particular because their high water content leads to excessive
artefactual shrinkage in more conventional fixatives, i.e. formol saline. The fixed tissues should be
processed for microscopic examination and interpreted at a laboratory that has specific experience
with equine endometrial biopsy samples and with equine gynaecology.
Cyclic histology: the microscopic architecture of the endometrium reflects the hormonal
status of the mare so changes that occur during oestrus, dioestrus and anoestrus can be classified
accordingly.
Histopathology: microscopic pathological abnormalities are usually mixed so specific
changes are classified and their significance is assessed in terms of the mare’s age and
gynaecological history. They can be conveniently classified as inflammatory (acute and chronic
endometritis) and non-inflammatory conditions, including endometrial hypoplasia, hyperplasia and
chronic degenerative conditions.
Acute endometritis is diagnosed by the presence of PMNs and, in severe cases, lumenal
epithelial degenerative changes, in endometrial biopsy samples taken at any stage of the non-
pregnant mare’s cycle. It is recognised that as mares age and suffer the gynaecological and
obstetric effects of a busy breeding career, their natural uterine defence mechanisms become less
competent and they become more susceptible to recurrent/persistent acute endometritis. These
defence mechanisms involve local endometrial factors and myometrial function.
Ultrasound scan may help to demonstrate the severity of inflammation by the degree of
endometrial oedema and the volume and scan appearance of retained lumenal fluid. Persistent
endometritis indicates an inflammatory response to semen and/or a contaminating microorganism
or microorganisms. Spermatozoa induce a physiological inflammatory reaction in the uterus,
which is an important part of normal sperm elimination. However, normal mares resolve the
inflammation within 24-36 and a failure to do this results in persistent endometritis. If the
endometritis is of bacterial origin, the associated organism(s) can be determined by bacteriological
examinations.
Persistent breeding-induced endometritis may resolve spontaneously with sexual rest.
Waiting for this to happen is often not practical during a short breeding season, and treatment
options include the intravenous administration of 10-25 iu oxytocin and/or uterine lavage with large
volume (1-2 L) of a buffered saline solution at 6-12 hours after breeding. The mare should be
considered susceptible to recurrent endometritis each time she is mated and appropriate
prophylactic measures should be taken. Infectious endometritis is treated with local infusions of
appropriate non-irritant, water-soluble antibiotics (e.g. 1 g ceftiofur sodium is recommended as a
useful ‘first choice’, although choice of antibiotics vary between clinicians, on grounds of
availability, experience and cost). Where there are signs of uterine fluid accumulation or
pyometritis/pyometra, large volume (3 litres) sterile saline irrigation, (sometimes including 3%
hydrogen peroxide) is recommended to remove uterine lumenal inflammatory fluids and debris
prior to starting antibiotic treatment. Irrigation is best performed via a uterine flushing catheter.
Uterine fluid clearance can be stimulated by transrectal massage of the uterus, or by the
intravenous administration of 10-25 iu oxytocin. Large volume uterine flushing, antibiotic therapy
and oxytocin treatment may be repeated daily or, if indicated, twice daily until ultrasound scan
examinations suggest resolution. In addition to local treatment with antibiotics, systemic treatment

247
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

may, on occasions, be indicated. Experience suggests that systemic antibiotic treatment alone is
of little value in the treatment of equine uterine infections. In most cases the infecting organism is
in the uterine lumen and the most superficial part of the endometrium rather than in the deeper
parts of the endometrial tissue. Thus local uterine lumenal treatments are likely to be the most
successful. The suitability of the preparation used for intra-uterine irrigation is very important
(irritant and incompletely dissolvable materials should be avoided) and 1 g ceftiofur sodium in 20
ml sterile water for injection has been found to be an excellent ‘first choice’ pending identification of
the pathogen(s) and specific antibiotic sensitivity test results.
Fungal infections of the uterus may produce clinical signs that vary from none, in which the
infection is lumenal and there is no tissue invasion, to severe purulent endometritis, demonstrable
by ultrasound scan. If persistent, these infections lead to conception failure or, if infection occurs
during pregnancy, to ascending placentitis and abortion. Treatment of mares with fungal infections
is generally more challenging than for bacterial infections. Common treatment strategies include
initial large volume (3 l daily or twice daily) uterine irrigations with sterile saline solution (sometimes
with added 3% hydrogen peroxide solution). Irrigation with dilute (0.5%) povidone iodine solutions
has been used but care must be taken to avoid severe genital inflammation in individual mares.
Culture and sensitivity will determine the choice of antifungal drugs. Daily intrauterine infusions for
7-10 days may be required to effectively resolve the infection. A single dose of a benzyoylphenyl
urea (Lufenuron) has been suggested to be effective in treating mares with fungal endometritis.
Additional systemic (oral) treatment with ketoconazole may help resolution in some cases.
The success or failure of treatment for acute endometritis is monitored by ‘follow-up’
endometrial smear/swab, ultrasound scan and/or biopsy examinations, taken 3–4 weeks after the
end of the course of treatment.
Chronic infiltrative endometritis is diagnosed by the presence of mononuclear cells
(histiocytes/lymphocytes and plasma cells) in biopsy specimens. The presence of these cells
indicates a local immune response and therefore previous or on-going challenge by semen or
infectious agents. If uncomplicated by other abnormalities, this natural immune response is
considered normal and no specific treatment is indicated. Occasionally, the immune response
appears excessive, occasionally to granulomatous proportions, when treatment with a prolonged
course of appropriate intrauterine antibiotics followed by a prolonged period of sexual rest may be
indicated to help remove chronic deep-seated foci of infection.
Chronic degenerative endometrial disease (endometrosis) is diagnosed by the
presence of glandular degenerative changes in biopsy specimens in the form of gland ‘nests’,
surrounded by lamellae of fibrous tissue or, less commonly, gland ‘cysts’, lined by glandular
epithelial cells. Peri-glandular, peri-vascular or, less commonly, diffuse stromal fibrosis and
angiopathy are seen. These degenerate glands are malfunctional. Diffuse stromal fibrosis is
considered to be a poor prognostic sign for the maintenance of future pregnancies. Pools of tissue
fluid lined by lymphatic endothelial cells (lymphatic ‘lacunae’) may be seen scattered in the stroma.
As these develop they become larger and migrate into the uterine lumen, attached to the
endometrium by a ‘stalk’ of lymphatic duct and connective tissue. These endometrial cysts, when
large enough, can be seen by ultrasound scan. It is unusual to sample a lymphatic cyst, using
conventional biopsy techniques.
Chronic endometrial degenerative changes are progressive and are associated most
importantly with the normal ageing process and cyclic hormonal effects. The repeated stimulatory
challenges of semen, micro-organisms, external genital and environmental debris, and the
physical challenges of obstetric difficulties may accelerate the progression of these changes and it
is possible that they may, to a large extent, account for the linear decline in fertility seen in the
Thoroughbred mare population with age (see above). These degenerative changes are frequently
seen in mares that suffer repeated pregnancy failure or prolonged gestation with foetal
dysmaturity. Degenerative changes are inevitable to a degree and thus each biopsy specimen
must be assessed in terms of the mare’s age and parity. The severity of these changes has been
shown to be correlated with age to an extent which suggests that, in general terms, mares up to 9
years of age should have no signs, mares up to 13 years of age should have no more than mild
signs, mares up to 15 years of age should have no more than moderate signs and mares of 17
years and older are likely to have advanced signs of chronic degenerative changes. Conversely,

248
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

successful normal reproductive activity also appears to slow the development of these changes,
suggesting that repeated successive normal pregnancy, without obstetric difficulty, helps maintain
a healthy endometrium. It is well recognised that older maiden mares, e.g. performance mares
who retire later in life than Thoroughbred mares, frequently have degenerative changes in their
biopsy specimens to degrees that are markedly in excess of what would be considered acceptable
for their age. These mares often find difficulty in achieving a successful first pregnancy.
Conversely, old Thoroughbred mares that have produced foals year after year since 4 years of
age, without failures and while managing to avoid obstetrical difficulties, have chronic endometrial
degenerative changes that suggest a much younger age. It is probably that the periodic
interruptions to ovarian steroid hormone cyclicity that pregnancies afford have a ‘protective’ effect
on endometrial gland integrity. The ‘moral’ of the story for mare management is therefore good
gynaecological and obstetric management and avoiding years of reproductive rest.
Where the degree of degenerative change is considered excessive for age, treatment with
mechanical endometrial curettage may be attempted. Improvements in histopathological
appearance and fertility can be expected in some mares, more reliably in those who are less than
17 years old. If this technique is of value, it must be by mild stimulation of endometrial blood
supply. Attempts at chemical curettage are best avoided because the severity and complications
of its effects in individual mares are unpredictable and uncontrollable. If such treatments result in
trans-lumenal adhesions or cervical damage, these may end the mare’s reproductive career.
Endometrial atrophy is diagnosed by loss of normal glands from the endometrium.
Temporary diffuse glandular atrophy is seen following prolonged ovarian inactivity and is therefore
a normal temporary feature during winter anoestrus. This is seen in some mares with ovarian
functional depression associated with ovarian granulosa cell tumours. True endometrial atrophy,
with lumenal and glandular atrophy, may be seen in aged mares, usually in association with senile
ovarian malfunction and is an ‘end-stage’ process. Rarely, true endometrial atrophy has been
seen in younger mares following severe recurrent acute endometritis with P. aeruginosa infection.
No treatment is successful for true endometrial atrophy and retirement is the most practical option.
Endometrial hypoplasia is diagnosed by signs of diffuse glandular under-development and
has been seen in young barren maiden mares, sometimes in association with ovarian cyclic
irregularities. It appears to be a feature of relative genital immaturity and usually resolves, without
treatment, in time. In a young maiden mare, where the degree of hypoplasia is marked and
ovarian size is minimal, or where the condition persists, the possibility that fundamental ovarian
abnormality (gonadal dysgenesis) is involved should be considered and chromosome analysis
(karyotype) should be performed.
Endometrial hyperplasia is diagnosed by signs of endometrial glandular over-activity.
Glandular hyperplasia with hypersecretion is a normal feature of the post-partum or post-
pregnancy failure period and normal glandular architecture and secretory activity is usually
achieved by 10 to 12 days but occasionally may persist for weeks if not months, when it is
considered pathological. In such cases, acute endometritis is often a complicating feature.
Treatment with the intravenous administration of 10-25 iu oxytocin often gives good results. It is
believed that oxytocin may reduce endometrial hyperplasia via its endometrial vasoconstrictive
effect, as reported in other species. Acute endometritis, where involved, should be treated as
discussed above.
In some cases, recurrent acute endometritis appears to produce diffuse glandular
hyperplasia, probably associated with short cycling and hyperoestrogenism. Successful treatment
of the acute endometritis will reduce the signs of diffuse glandular hyperplasia and treatment with
oxytocin appears to aid resolution.
Other uterine abnormalities
Endometrial lymphatic cysts: The development of these cysts has been discussed above.
They are commonly seen during ultrasound scan examinations in multiparous mares over 14 years
old. They can be seen during ultrasound scan examination because the lymphatic fluid that they
contain is anechoic. The cysts may be unilocular or multilocular. They are frequently inconvenient
in that they may confuse pregnancy examinations, but otherwise, unless very large where they
may prevent the normal intrauterine mobility of the pre-fixed embryo, essential for early recognition
of pregnancy and/or they are widespread throughout the uterus, they appear to have no specific

249
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

effect on fertility. They can, if considered necessary, be visualised and removed with laser
ablation or loop-wire thermocautery via a videoendoscope.
Trans-lumenal fibrous adhesions: These may follow obstetrical injuries or the injudicious
intrauterine use of irritant chemicals. If widespread and diffuse, these are untreatable and the
mare is most sensibly retired. If focal and discrete, they may be removed with laser ablation,
thermocautery or removal by biopsy attachment, via a videoendoscope, with variable success in
terms of future fertility.
Intra-uterine foreign bodies: Use of the videoendoscope in mares with recurrent non-
responsive endometritis has revealed, in some cases, lumenal foreign bodies consisting of
placental remnants, cotton wool (presumably swab tip fragments) and amorphous debris with a
central core of multiplying bacteria or unidentifiable degenerate debris. Once removed with a
biopsy attachment, via a videoendoscope, these cases responded to treatment for acute
endometritis.
Endometrial neoplasia: Leiomyomas and fibroleiomyomas are uncommon but are the most
frequently diagnosed equine endometrial tumours. They are usually small and benign and have
no primary effect on fertility. They may be obstructive and may bleed. Treatment, by laser
surgery, via a videoendoscope or surgical removal via hysterotomy, via laparotomy or
laparoscopy, is only indicated where the tumour is large, when it may be pedunculated, and may
cause persistent endometrial haemorrhage and secondary endometritis. Malignant endometrial
adenocarcinoma has been only rarely recorded. One such case had respiratory signs and
necropsy examination confirmed pulmonary metastases.
Videohysteroscopic examinations
Examinations are best made with the videoendoscope, which gives better visualisation than
is possible with conventional fibreoptic technology endoscopes. Endometrial lymphatic cysts, fluid
accumulations, fibrous adhesions, foreign bodies and endometrial tumours may be visualised and
sometimes removed, using laser or thermocautery instruments. Biopsy specimens obtained with
instruments supplied for passage through the endoscope are too small to be diagnostically useful.
Conventional basket-jawed endometrial biopsy forceps can be passed alongside the endoscope
and visually directed samples can be obtained.
Laparoscopic examinations
This technique has been used to study ovulation in mares and to treat blocked fallopian
tubes with external applications of prostaglandins. Fallopian tube blockage is a rare condition in
mares.
Expertise and experience with equine laparoscopic surgery has improved markedly during
recent years and neoplastic ovaries and intractable ovarian haematomas are now most commonly
removed by this technique, with the mare standing under sedation and local analgesia. The
technique may be used for intra-pelvic exploration of the genitalia in specific cases.
Exploratory Laparotomy
Rarely, mid-line or flank laparotomy, with the mare under general anaesthesia, may be
indicated for the investigation and/or treatment of uterine abnormality.
Extra-uterine abnormalities
Organising broad ligament haematomas or pelvic adhesions may be detected by their
palpably hard consistency and their homogeneous appearance on ultrasound scan examination.
Peri-uterine abscesses sometimes follow obstetric injuries and these require intensive medical
treatment with systemic antibiotic therapy.
Prognosis for future breeding
Some mare owners request a prognosis for the chances for successful future breeding to
help with mating plans or to help with the decision to retire the mare. While this is an
understandable request, prognoses should be made with great caution. Prognoses are most
usefully and more accurately made, in 2 stages, on the following basis:-
1. Following the first examination and biopsy, aged mares with true (not seasonally-
induced) endometrial atrophy, i.e. in effect, senility, and young maiden mares with
fundamental chromosome abnormalities (gonadal dysgenesis) are appropriately retired at
this stage. Mares with recurrent acute endometritis and those with severe chronic

250
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

endometrial degenerative disease invariable demonstrate increased clinical ‘susceptibility’

to uterine infection.
2. Following the second, i.e. follow-up examination and biopsy, failure to improve, or
deterioration after specific uterine treatments and, where necessary, further examinations
and further specific treatments have been performed are considered very poor prognostic
signs.
Subsequent management
After a satisfactory follow-up examination, a management plan is formulated to help the
individual mare compensate for her residual abnormalities. The aim is to limit uterine exposure to
semen and bacteria, and to assist the uterus to physically clear contaminants and inflammatory
products after breeding. This can be achieved, in populations of horses where registration
authorities allow, by the use of artificial insemination (AI) with antibiotic-extended semen:
1. Satisfactory endometrial swab and smear test results are obtained at the current
oestrous period, i.e. no signs of acute endometritis.
2. An apparently normal, developing, mature ovarian follicle is palpable.
3. Insemination is arranged as close as possible to the estimated time of likely ovulation.
Ovulation may be aided by the administration of hCG or a GnRH analogue.
AI using a semen extender that contains antibiotics is performed.
4. Physical clearance following breeding can be assisted by the use of oxytocin and/or
uterine lavage.
a. Oxytocin or PGF2a treatment at 4-8 hours after breeding will effectively aid in
uterine clearance, resulting in improved pregnancy rates in susceptible mares. Data
suggest that a lower dose of oxytocin (5-10 IU) may be more effective than higher
doses, in promoting uterine clearance. Care must be taken with regards to the timing
of PGF2a treatment. PGF2a can cause a delay in the formation of a functional CL when
administered within 2 days after ovulation, potentially causing pregnancy failure.
b. Large-volume uterine lavage at 6-12 hours after breeding will also effectively
assist in clearing the uterus from fluid and inflammatory products. Because sperm
transport to the oviduct is completed within 4 hours after breeding, uterine lavage
between 6-12 hours after breeding will have no adverse effect on fertility.
c. Manual dilation of the cervix in mares with poor cervical dilation may help these
mares to more effectively clear their uteri of fluid.
5. AI should be limited to once per oestrous period, since each exposure to semen
induces an inflammatory response.
Where AI is not applicable, i.e. in Thoroughbred horses, ‘minimal contamination breeding
techniques’ may be used with natural mating. These consist of:-
1. Satisfactory endometrial swab and smear test results are obtained at the current
oestrous period.
2. An apparently normal, mature, developing ovarian follicle is palpable.
3. Mating is arranged as close as possible to the estimated time of likely ovulation.
4. Pre-breeding semen extender, containing low-fat skimmed milk powder (2.5 g),
gelatine (0.5 g), glucose (5.0 g), crystalline penicillin (300 mg), crystalline streptomycin
(300 mg) dissolved in 100 ml sterile water for injection, may be instilled into the mare’s
uterus as soon as possible prior to mating, if considered appropriate. The powdered
mixture may be stored at -4oC in sealed plastic sachets, prior to use following
reconstitution at 37oC in 100 ml sterile water for injection.
5. LH in the form of hCG or a GnRH analogue is used to hasten ovulation.
6. The uterus is flushed with 1-3 l sterile saline (depending on size of mare/uterus) and
then treated with a water-soluble, non-irritant, broad-spectrum antibiotic solution to which
the common equine uterine aerobic and anaerobic pathogens are sensitive (e.g. 1 g.
ceftiofur sodium in 20 ml sterile water for injection), 12–24 h after mating, followed by 10-
25 iu oxytocin administered iv to aid uterine clearance. This may be repeated 24 hours
and occasionally 48 hours later, depending on the circumstances of the individual case.
7. A second mating during that oestrous period is not recommended.

251
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

Management for ‘high risk’ during achieved pregnancies

Pregnancies achieved from mares with compromised uteri should be identified as ‘high risk’
and should be monitored by watching the mare’s udder and in appropriate cases by serial
ultrasound scan examinations. Unnecessary maternal stress should be avoided throughout
pregnancy. Prolonged gestation sometimes occurs in mares with advanced chronic endometrial
degenerative disease and this identifies the foetus as ‘high risk’ and neonatal critical care facilities
should be prepared for use, when required.
Ultrasonographic examinations of the placenta in mares that are considered to be at risk for
abortion during late gestation can be performed by transabdominal and transrectal approaches.
Transabdominal Ultrasonographic examinations
Using a 3.5 or 5 MHz sector scanner, four quadrants of the placenta (right cranial, right
caudal, left cranial, and left caudal) should be examined by the transabdominal approach. Mares
with normal pregnancies should have a minimal combined thickness of the uterus and the placenta
(CTUP) of 7.1±1.6 mm, and a maximal CTUP of 11.5±2.4 mm. Pregnancies with an increased
CTUP have been associated with the delivery of abnormal foals. The caudal portion of the
allantochorion cannot be imaged by this approach, preventing the clinician from diagnosing
ascending placentitis in its early stages. However, placental thickening and partial separation of
the allantochorion from the endometrium may be observed in mares with placentitis originating
from a haematogenous infection.
Transrectal Ultrasonographic examinations
Imaging the caudal allantochorion in late gestational mares provides an excellent image of
the placenta close to the cervical star. A 5 MHz linear transducer should be positioned 1-2 inches
cranial of the cervical-placental junction, and then moved laterally until the middle branch of the
uterine artery is visible at the ventral aspect of the uterine body. The CTUP should then be
measured between the middle branch of the uterine artery and the allantoic fluid. The clinician
must make sure that the amnion is not adjacent to the allantochorion, since this may result in a
false increased CTUP. It is important to obtain all CTUP measurements from the ventral aspect of
the uterine body, since oedema of the dorsal aspect of the allantochorion has been noted in
normal pregnant mares during the last month of gestation. Increases in CTUP >8 mm between
day 271 and 300, >10 mm between day 301 and 330, and >12 mm after day 330 have been
associated with placental failure and impending abortion. In advanced stages of placentitis,
hyperechoic fluid may be imaged in the space between the uterus and the placenta.
The equine placenta is part of an endocrine foetoplacental interaction, which synthesizes
and metabolizes progestagens. Mares with advanced stages of placentitis or placental separation
may have increased plasma concentrations of progestagens as a result of stress to the
foetoplacental unit. Since foetoplacental progesterone is rapidly metabolized to 5alpha-
pregnanes, its metabolites may not be recognized by all commercial progesterone assays.
Therefore, maternal serum progesterone concentrations in late pregnant mares do not always
reflect the conditions in the uterus. Mares that develop a chronic form of placentitis respond with
increased plasma progesterone concentrations, while mares that developed acute placentitis and
abortion soon after infection experienced a drop in plasma progesterone concentrations.
Therefore, measurement of repeated samples of plasma progestagen concentrations in mares
with placentitis may be a useful method to identify those that may abort or deliver prematurely.
Treatment of mares with placentitis should be aimed toward elimination of the infectious
agents, reduction of the inflammatory response, and reduction of the increased myometrial
contractility in response to the ongoing inflammation. Poor perineal confirmation, urine pooling,
and cervical lesions should be corrected prior to breeding to prevent an ascending route of
infection during pregnancy. Mares with clinical signs of placentitis, or abnormal placental findings
upon ultrasonographic evaluation may be treated with broad-spectrum antibiotics (e.g.
trimethoprim sulpha), anti-inflammatory medication (flunixin meglumine, 1.1 mg/kg BID or
phenylbutazone, 4 mg/kg BID), and tocolytics (altrenogest, 0.088 mg/kg SID or clenbuterol, 0.8
µg/kg BID). Pentoxifylline (7.5 mg/kg per os BID) has been suggested to increase oxygenation of
the placenta. Bacterial and fungal cultures should be obtained in mares with vaginal discharge for
isolation of a causative agent and sensitivity to antibiotics. Following foaling or abortion, the entire
placenta (and foal in case of abortion) should be submitted for necropsy examinations. The

252
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

endometrium should be cultured and the mare should be treated for endometritis if the placental
cultures suggest infection.
Has progress been made?
Weatherbys annual returns made by owners of Thoroughbred mares in the United Kingdom
and Ireland report that during the 29 years from 1977 to 2006, the number of mares registered as
‘mated by registered Thoroughbred stallions’ has increased from 14,556 to 23,415 and the number
of live foals from 8,099 to 17,121. When these data are presented in terms of percentage of
mares mated (minus ‘no returns’ and ‘mares dead and exported’, for whom accurate data is not
available), encouraging trends emerge. Conception rate has increased from 77.5% to 97.1%.
Similarly, live foal rate has increased from 68.1% to 88.8%. Barren mare rate has decreased from
22.5% to 11.1%. Gestational failure rate has reduced from 9.4% to 8.3%. Closer examination of
the latter data shows a downward trend from 1977 to 1989, followed by a rise which is believed to
be associated with the widespread use of ultrasound scan examinations making possible the
diagnosis of early gestational failure which has since been reflected in mare owners’ returns.
Since then it appears that some progress has been made to decrease pregnancy losses.
The progressive fall in the barren mare rate by more than 50% over the last 23 years is
particularly encouraging. Although it is only possible to speculate on the probable multifactorial
causes of this improvement, one must hope that progress in mare management and equine
gynaecology has at least played a useful part.
Conclusions
Few mares are truly infertile and with an accurate diagnosis, rational treatment and careful
management, most can be encouraged to breed successfully. Preparing the barren mare for the
new breeding season early is essential to maximise chances for an early successful pregnancy
and to help prolong the mare’s long-term breeding career. Management ‘teamwork’ is a vital factor
and sufficient commitment is required from the owner, in terms of interest and finance, from the
studfarm manager, in terms of interest and staff time and facilities, and from the veterinarian, in
terms of interest, time, knowledge, expertise, experience and provision of the necessary
equipment.

Further reading
Aanes, W.A. (1993) Cervical laceration(s). In Equine Reproduction, Ed. A.O. McKinnon
and J.L. Voss, Lea and Febiger, 444-449.
Bailey, M.T., Wheaton, J.E. & Troedsson, M.H.T. (2002) Inhibin concentrations in mares
with granulosa cell tumors. Theriogenology 57, 1885-1895.
Baker, C.B. & Kenney, R.M. (1980) Systematic approach to the diagnosis of the infertile
or subfertile mare. In Current Therapy in Theriogenology. Ed. D.A. Morrow. W.B. Saunders
Co., Philadelphia, USA. 721-735.
Bergman, R.V. & Kenney, R.M. (1975) Representativeness of a uterine biopsy in the
st
mare. Proc. 21 . Ann. Conv. Am. Ass. equine Practnr. 355-362.
Blue, M.G. (1987), Fungal endometritis. In Current Therapy in Equine Medicine. 2nd.
Edit., Ed. N.E. Robinson, W.B. Saunders, Philadelphia, 511-512.
Brendemuehl, J.P. (2002) Effect of oxytocin and cloprostenol on luteal formation,
function and pregnancy rates in mares. Theriogenology 58, 623-626.
Brown, J.S., Varner, D.D., Hinrichs, K. & Kenney, R.M. (1984) Surgical repair of the
lacerated cervix in the mare. Theriogenology 22, 351.
Campbell, M.L.H., & England, G.C.W. (2002) A comparison of the ecbolic efficacy of
intravenous and intrauterine oxytocin treatments. Theriogenology 58, 473-478.
Caslick, E.A. (1937) The vulva and vulvo-vaginal orifice and its relation to genital health
of the Thoroughbred mare. Cornell Vet. 27, 178.
Chandley, A., Fletcher, J., Rossdale, P.D., Peace, C.K., Ricketts, S.W., McEnery, R.J.,
Thorne, J.P., Short, R.V. & Allen, W.R. (1975) Chromosome abnormalities as a cause of
infertility in mares. J. Reprod. Fert. Suppl. 23, 377-383.
Doig, P.A., McNight, J.D. & Miller, R.B. (1981) The use of endometrial biopsy in the
infertile mare. Can. Vet. J., 22, 72-76

253
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

Eilts, B.E., Svholl, D.T., Paccamonti, D.L., Causey, R., Klimeczak, J.C. & Corley, J.R.
(1995) Prevalence of endometrial cysts and their effect on fertility. Biol. Reprod. Mono. 1, 527-
532.
Evans, L.H., Tate, L.P., Cooper, W.L. & Robertson, J.T. (1975) Surgical repair of cervical
st
lacerations and the incompetent cervix. Proc. 21 . Ann. Conv. Am. Ass. equine Practnr. 483-
486.
Geor, R.J., Weiss, D.J., Burris, S.M. and Smith, C.M. (1992) Effects of furoseminde and
pentoxifylline on blood flow properties in horses. Am. J. Vet. Res. 53, 2043-2049.
Ginther, O.J. (1986) Ultrasonic imaging and reproductive events in the mare.
Equiservices, Cross Plains, Wisconsin, USA.
Ginther, O.J. (1988) Ultrasonic imaging of equine ovarian follicles and corpora lutea. Vet.
Clin. N. Am. Equine Pract., 197-213.
Greenhof, G.R. & Kenney, R.M. (1975) Evaluation of the reproductive status of
nonpregnant mares. J. Am. vet. med. Ass. 167, 449.
Gruninger B., Schoon H-A., Schoon D., Menger S., Klug E. (1998) Incidence and
morphology of endometrial angiopathies in mares in relationship to age and parity. J. Comp.
Path. 119, 293-309.
Hess, M.B., Parker, N.A., Purswell, B.J., et al. (2002) Use of lufenuron as a treatment for
fungal endometritis in four mares. J. Am. vet. med. Assoc. 221, 266-267.
Hughes, J.P. & Loy, R.G. (1969) Investigations on the effect of intrauterine inoculations
of Streptococcus zooepidemicus in the mare. Proc. 15th. Ann. Conv. Am. Ass. equine Practnr.
289-292.
Jeffcott, L.B., Rossdale, P.D., Freestone, J., Frank, C.J. & Towers-Clark, P.F. (1982) An
assessment of wastage in Thoroughbred racing from conception to 4 years of age. Equine vet.
J. 14, 185-198.
Kenney, R.M. (1978) Cyclic and pathologic changes in the mare endometrium as
detected by biopsy with a note on early embryonic death. J. Am. vet. med. Ass., 172, 241.
Kenney, R.M., Bergman, R.V., Cooper, W.L. & Morse, G.W. (1975) Minimal
contamination techniques for breeding mares: technique and preliminary findings. Proc. 21st.
An. Conv. Am. Ass. equine Practnr., 327.
Kenney, R.M. & Ganjam, V.K. (1975) Selected pathological changes of the mare uterus
and ovary. J. Reprod. Fert. Suppl.. 23, 335-339.
Kucheriavenko, A.N. (1985) Effect of trental on placental transport function and fetal
development in hypotrophy. Akush Ginekol. (Moscow), 4, 67-69.
LeBlanc, M.M. (1992) Vaginal examination. In Equine Reproduction, Editors A.O.
McKinnon & J.L. Voss, Williams & Wilkins, 221-224.
nd
Liu, I.R.W. (1987) Ovarian abnormalities. In Current Therapy in Equine Medicine, 2 .
Edit., Ed. N.E. Robinson, W.B. Saunders, Philadelphia, 500-502.
Madill, S., Troedsson, M.H.T., Santschi, E.M. (1997) Individual registration of longitudinal
and circular muscle in the equine endometrium using electromyography and strain gauges:
Preliminary data. In Havermeyer Foundation International Workshop on Uterine defense
mechanisms in the mare: Aspects of physical clearance. 10 (abstr).
McCue, P.M. (1992) Equine granulosa cell tumors. Proc. Am. Ass. equine Practnrs. 38,
587-593.
McCue, P.M., & Squires, E.L. (2002) Persistent anovulatory follicles in the mare.
Theriogenology 58, 541-543.
McKinnon, A.O. & Carnevale, E.M. (1992) Ultrasonography. In Equine Reproduction,
Editors A.O. McKinnon & J.L. Voss, Williams & Wilkins, 211-220.
Morris, L.H.A. & Allen, W.R. (2002) Reproductive efficiency of intensively managed
Thoroughbred mares in Newmarket. Equine vet. J. 34, 51-60.
Nambo, Y., Oikawa, M-A., Yoshihara, T., Kuwano, A. & Katayama, Y. (1995) Age-related
Morphometrical changes of arteries of uterine wall in mares. J. Vet. Med. A., 42, 383-387.
Peterson, F.B., McFeely, R.A. & David, J.S.E. (1969) Studies on the pathogenesis of
endometritis in the mare. Proc. 15th. Ann. Conv. Am. Ass. equine Practnr. 279-288.

254
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

Pouret, E.J.M. (1982) Surgical technique for the correction of pneumo- and urovagina.
Equine vet. J. 14, 249.
Pycock, J.F. (1994) Assessment of oxytocin and intrauterine antibiotics on intrauterine
fluid and pregnancy rates in the mare. Proc. Am. Assoc. equine Practnrs. 40, 19-20.
Rasch, K., Schoon, H-A, Sieme, H, et al. (1996) Histomorphological endometrial status
and influence of oxytocin on the uterine drainage and pregnancy rates in mares. Equine vet J.
28, 455-460.
Reef, V.B., Vaala, W.E., Worth, L.T., et al. (1996) Ultrasonographic assessment of fetal
well being during late gestation: development of an equine biophysical profile. Equine vet. J.
28, 200-208.
Renaudin, C., Troedsson, M.H.T., Gillis, C., et al. (1997) Ultrasonographic evaluation of
the equine placenta by transrectal and transabdominal approach in pregnant mares.
Theriogenology 47, 559-573.
Ricketts, S.W. (1975a) The technique and clinical application of endometrial biopsy in
mares. Equine vet. J. 7, 102-109.
Ricketts, S.W. (1975b) Endometrial biopsy as a guide to diagnosis of endometrial
pathology in the mare. J. Reprod. Fert. Suppl. 23, 341-345.
Ricketts, S.W. (1978) Histological and histopathological studies on the endometrium of
the mare. Fellowship Thesis, R.C.V.S., London.
Ricketts, S.W. (1981) Bacteriological examinations of the mare’s cervix: techniques and
interpretation of results. Vet. Rec. 108, 46.
Ricketts, S.W. (1985), Endometrial curettage in the mare. Equine vet. J. 17, 324-328.
Ricketts, S.W. (1987a) Perineal conformation abnormalities. In Current Therapy in
nd
Equine Medicine. Ed. N.E. Robinson, 2 Edition, W.B. Saunders Co., 518-520.
Ricketts, S.W. (1987b), Uterine abnormalities. In Current Therapy in Equine Medicine,
2nd. Edit., Ed. N.E. Robinson, W.B. Saunders, Philadelphia, 503-507.
Ricketts, S.W. (1989a) The barren mare: Diagnosis, prognosis, prophylaxis and
treatment for genital abnormality. Part 1. In Practice, 11, 119-125.
Ricketts, S.W. (1989b) The barren mare: Diagnosis, prognosis, prophylaxis and
treatment for genital abnormality. Part 2. In Practice, 11, 156-164.Weatherbys (2003).
Ricketts, S.W. (1997) Treatment of equine endometritis with intrauterine irrigations of
ceftiofur sodium: a comparison with mares treated in a similar manner with a mixture of sodium
benzylpenicillin, neomycin sulphate, polymixin B sulphate and furaltadone hydrochloride.
Pferdeheilkunde 5, 486-489.
Ricketts, S.W. (1996) Contagious Endometritis (CEM). Equine vet. Educ. 8, 166-170.
Ricketts, S.W. & Alonso, S. (1991a) Assessment of the breeding prognosis of mares
using paired endometrial biopsy techniques. Equine vet. J. 23, 185-188.
Ricketts, S.W. & Alonso, S. (1991b) The effect of age and parity on the development of
equine chronic endometrial disease. Equine vet. J. 23, 189-192.
Ricketts, S.W. & Mackintosh M.E. (1987) The role of anaerobic bacteria in equine
endometritis. J. Reprod. Fert. Suppl. 35, 343-351.
Ricketts, S.W. & Troedsson, M.H.T. (2006) Barren Mares - fertility expectations and
management for optimal fertility. In Current Therapy in Equine Reproduction. Eds. Samper and
Pycock, Elsevier. pp. 53-69
Ricketts, S.W., Young, A. and Medici, E.B. (1993) Uterine and clitoral cultures. In Equine
Reproduction. Ed. A.O. McKinnon & J.L. Voss, Lea & Febiger. 234-245.
Sheerin, P.C., Morris, S., Kelleman, A., et al. (2003) Diagnostic efficiency of transrectal
ultrasonography and plasma progestin profiles in identifying mares at risk of premature delivery.
st
In: Proc. 1 Ann. Focus Meeting Am. Ass. equine Practnrs. 22-23.
Stawicki RJ, Ruebel H, Hansen PJ, et al. (2002) Endocrinological findings in an
experimental model of ascending placentitis. Theriogenology 58, 849-852.
Troedsson, M.H. (1999) Uterine clearance and resistance to persistent endometritis in
the mare. Theriogenology 52, 461-471.

255
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
Published in IVIS with the permission of the WEVA Close this window to return to IVIS

Troedsson, M.H., deMoraes, M.J. & Liu, I.K. (1993) Correlations between histologic
endometrial lesions in mares and clinical response to intrauterine exposure with Streptococcus
zooepidemicus. Am. J. Vet. Res., 54, 570-572.
Troedsson, M.H.T., Scott, M.A., Liu, I.K.M. (1995) Comparative treatments of mares
susceptible to chronic uterine infection. Am. J. Vet. Res. 56, 468-472..
Troedsson, M.H.T., Renaudin, C.D., Zent, W.W., and Steiner, J.V. (1997) Transrectal
ultrasonography of the placenta in normal mares and in mares with pending abortion: A field
study. Proc. Am. Ass. equine Practnrs. 43, 256-258.
Troedsson, M.H.T., Ohlgren, A.F., Ababneh, M., and Gregas, M. (2001) Effect of
periovulatory prostaglandin F2a on pregnancy rates and luteal function. Theriogenology 55,
1891-1899.
Trotter, G.W. (1993) Surgery of the perineum of the mare. In Equine Reproduction. Ed.
A.O. McKinnon and J.L. Voss, Lea and Febiger, 417-427.
Watson, E.D. (1988) Uterine defence mechanisms in mares resistant and susceptible to
persistent endometritis: a review. Equine vet. J. 20, 397-400.
Watson, E.D. (2000) Post-breeding endometritis in the mare. Anim. Reprod. Sci. 60-61,
221-232.
Whitwell, K.E. (1980) Investigations into fetal and neonatal losses in the horse. Vet.
Clin. N. America: Large Anim. Pract., 2, 313-331.
Wingfield Digby, N.J. (1978) The technique and clinical interpretation of endometrial
cytology in mares, Equine vet. J. 10, 167-170.
Wingfield Digby, N.J. & Ricketts, S.W. (1982) Results of concurrent bacteriological and
cytological examinations of the endometrium of mares in routine studfarm practice 1978-1981.
J. Reprod. Fert. Suppl. 32, 181-185.

256
Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia