Caesarean section in the mare: a retrospective study on 23 cases (1992-2008)

Caesarean section represents a surgical option for severe cases of dystocia and other emergencies of the pregnant mare, like uterine torsion and colic. It is normally performed as a surgical emergency and the time spent between the initial diagnosis of dystocia and referral is considered critical for foal survival. More rarely, caesarean section is performed as elective surgery. The present study aims at reviewing diagnosis, surgical treatment and outcome of mares operated for caesarean section at our clinic between 1992 and 2008. Three aspects of the surgical technique were considered relevant in the purpose of our study: the surgical access by median celiotomy, the intraoperative manual removal of placenta and the s.c. haemostatic suture performed on the border of uterine mucosa before closing the uterus with double inverting suture. Twenty-three mares were operated (20 for dystocia, 3 for uterine torsion). In 76,4% of cases, the cause of dystocia was malpositioning of the foetus, one mare had dead twins and in one case the position was normal but the foetus was hydrocefalus. Three foals were extracted alive and 2 were dismissed, one died the day after surgery for immaturity (the mare was at 300 days of gestation). Twenty-two mares (95%) were discharged, one mare died for paralytic ileus caused by adhesion of jejunum to the suture line on abdominal fascia. Recovery was uneventful in all cases and no cases of endotoxaemia, laminitis or hemorrhage were recorded, despite a moderate lowering of PCV recorded in few mares. Long term follow up was possible only in 12 mares. Five were still used for reproduction and all resulted pregnant and delivered a live foal the next season. Results of this study confirm that caesarean section can be successfully performed by median celiotomy and that intraoperative manual removal of placenta and haemostatic suture are useful tools to prevent severe complications like endotoxaemia, laminitis and hemorrhage.