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Review of the Uses of Transrectal Ultrasound to

Assess Pregnancy & Reproductive Health In Mares


Maria R. Schnobrich VMD, DACT
Rood and Riddle Equine Hospital

Transrectal ultrasonography for reproductive management of the mare has become a


necessary tool for accurate and early detection of reproductive tract pathology, pregnancy
diagnosis, twin elimination, and recognition of pathologic changes of the feto-placental unit.
Transrectal ultrasonography of the reproductive tract of the mare is effectively performed using a
high-frequency 5-7.5MHz linear transducer. Transcutaneous evaluation later in gestation is best
performed using a 3-5 MHz curvilinear transducer. Familiarity with normal ultrasonographic
findings at different stages of pregnancy or in the non-pregnant mare allows one to faster identify
pathologic changes, intervene, and successfully treat these potential issues. Below are some
suggested normal transrectal ultrasound findings during various stages of gestation, as well as
some clinical applications of transrectal ultrasound in the non-pregnant mare that may help you
identify and address reproductive tract pathology.

ULTRASONOGRAPHY IN THE PREGNANT MARE


One of the most important uses of ultrasound in mare breeding management is the ability
to detect and eliminate twins early in gestation in breeds predisposed to twinning
(Thoroughbreds, Warmbloods). This screening is routinely performed prior to day 16 post-
ovulation. This development has allowed practitioners to successfully eliminate a twin pregnancy
with what has been reported to result in no significant difference in live foal rate to the remaining
pregnancy1, 3. Transrectal ultrasound is also useful in assessing pregnancy viability at all stages
of gestation. In early gestation it can be used to assess embryonic growth and anatomy of the
growing conceptus to make sure development is consistent with published normal values.
Evaluation of pregnancy viability prior to the formation of endometrial cups at approximately
day 35 of gestation is important, as the decision to terminate an abnormal pregnancy may avoid
the risk of persistent endometrial cups and a lost season. Later in gestation the evaluation of the
reproductive tract, fetus and feto-placental unit by transrectal and trans-abdominal
ultrasonography has been helpful in identifying placentitis, hydrops amnion or allantois,
determining fetal orientation or fetal gender, and assessing fetal well-being. Below are some
normal values and key time points that may be helpful when using transrectal ultrasonography to
monitor a mare’s pregnancy.

Embryonic Vesicle Size


The embryonic vesicle size refers to the measurement obtained in the dorso-ventral plane in a
cross-section of the uterus. It has been demonstrated that undersized vesicles indicated eventual
loss in approximately 62% (21/34) mares2, thus making size an important parameter in assessing
pregnancy viability. Position of the embryonic vesicle during the mobility phase is important as
well, as vesicles that spend the majority of time in the uterine body were associated with
increased loss.2

Determining Embryonic Age By Diameter (mm)


From O. J. Ginther “Ultrasonic Imaging and Animal Reproduction: Horses” Page1532
How to use
diagram:
Follow the dotted
line from a measured
height to the curved
line, then follow
dotted regression line
to day scale. Age can
be determined with
95% accuracy within
+/- 1.6 days for
vesicles 6-23 mm.

-Height should be
measured in dorso-
ventral plane
-3 day 95%
confidence interval
between 6-23mm
-8 day 95%
confidence interval
between 27-56mm

.
The recommended days of gestation that pregnancy evaluations are performed using transrectal
ultrasound can vary between practitioners. Below is a suggested timeline of evaluations and
checkpoints to identify potential problems, ensure pregnancy health, and allow an opportunity to
breed again if the pregnancy is lost:
1) Day 14 and Day 16: Identify pregnancy and eliminate a twin vesicle if needed prior to the
end of the mobility phase. After day 16 post-ovulation it becomes more difficult to
manipulate the vesicles or separate them for elimination. The early check at day 14
allows for determination of uterine health (excessive edema, relaxed cervix, free fluid,
low progesterone levels) to determine if intervention is needed (supplemental
progestogens, anti-inflammatories, antibiotics).
2) Day 28-30: To ensure presence of fetal heartbeat, identify twin vesicles if previously not
seen and before endometrial cup formation. Evaluate the conceptus’ position within the
uterus, and normal development.
3) Day 40-45: To determine normal anatomy of conceptus, confirm heartbeat, and presence
of normal anechoic fetal fluids, often considered an elective check.
4) Day 60-65: Assess fetal gender, heartbeat, character of fetal fluids.
5) Day 90: May consist of only a transrectal palpation, as the pregnancy has dropped over
the pelvic brim and the fetus can be difficult to stage at this time
6) Day 110-220: Often the “late summer/fall check”. Traditionally performed by palpation
alone. Using transrectal or transabdominal ultrasound, this can be an opportunity to
assess fetal health, gender (gonads or external genitalia or teats), and placental health
(CTUP, echogenicity of the fetal fluids).
7) Day 220-term: Most practitioners will not be asked to evaluate mares unless there is a
suspicion of placentitis (premature mammary gland development, vaginal discharge), the
mare has a history of abnormal pregnancy, or the mare has become systemically ill and
there is concern regarding fetal well-being.

Normal Early Gestation Development & Ultrasound Findings


1) At day 10 the vesicle should be
approximately 3 mm, and from day 10-17
post-ovulation in horses, the conceptus
should grow 3 mm/day in diameter. Day
17-20 the vesicle becomes irregular in
shape.
2) By day 16 of gestation the embryonic
vesicle should be at the base of one of the
uterine horns.
3) Day 18-26 there is a plateau in the growth
phase and minimal growth in the dorso-
ventral plane is appreciated.
4) Day 21 the embryo proper is first
visualized at the ventral aspect of the
embryonic vesicle.
5) From day 28 post-ovulation onward the
vesicle should grow 1.8mm/day.
6) Day 29 the allantoic sac is equal in volume
to the yolk sac, causing the embryo proper
to be located in the center suspended by
the adjacent yolk sac and allantoic
membranes.
7) Day 40 fetal length (crown-rump) should
be 24mm and should grow 1.7mm/day
until day 50. At this time the fetus is
suspended from the dorsal wall and the
umbilicus will extend allowing the fetus to
Notes and illustration adapted from reach the ventral floor by 49 days.
O. J. Ginther, “Ultrasonic Imaging and
Animal Reproduction: Horses”2
Later in gestation the health of the fetus and placenta can be evaluated by trasrectal and trans-
abdominal ultrasound. Evaluation of the vagina and cervical region should be performed to
assess for free fluid, air, or separation of the chorioallantois from the endometrium, and the
regions which can be evaluated should be assessed for thickening of the placenta. Fetal fluids
should be assessed for echogenicity and depth. The orientation of the fetus can be determined by
locating the orbit or tail by transrectal evaluation, or the orientation of the rib cage by
transcutaneous ultrasound. Fetal heart rate, movement, and tone can be assessed, as well as
character and thickness of the amniotic membrane4.
Measurements of the combined thickness of the uterus and placenta (CTUP) taken just
cranial to the cervix, have been reported in normal mares and mares with placentitis and can
serve, in conjunction with other clinical signs, as a way to identify placental pathology. The
measurement is taken from the dorsal wall of the large cranial vaginal artery to the allantoic
surface just crania and lateral to the cervix. Below are the condensed estimates often used in
practice for the upper limits of normal mares CTUP taken in late gestation.

Gestation Length Normal CTUP


151-270 days <7mm
271-300 <8mm
301-330 <10mm
331- <12mm
Another study showed a minimum value in normal mares of 7.1+/- 1.6mm and a maximum
of 11+/-2.4mm4

ULTRASONOGRAPHY OF THE NON-PREGNANT MARE


There are many uses of transrectal ultrasound in the non-pregnant mare; this list is meant
to be a brief summary. The non-pregnant mare includes mares presented for breeding and
those not presented for breeding purposes, but suspected of pathology associated with the
reproductive tract.
In the non-breeding mare transrectal ultrasonography can help identify or rule-out the
following pathologies:
1) Ovarian origin: neoplasia, hematoma, abscess, adhesions
2) Uterine origin: aspiration of air into the uterus, evidence of endometritis (excessive
fluid+/- edema), neoplasia, foreign body, trauma, hematoma
3) Cervical origin: fibrosis, hematoma, fluid accumuluation
4) Vaginal origin: pneumovagina, vesicovaginal reflux, foreign body, neoplasia,
hematoma
5) Vestibular origin: abscess, neoplasia, non-patent vestibule-vaginal fold
6) Urinary tract origin: ruptured bladder, uroliths, ureteroliths, neoplasia, hematoma

In the mare presented for breeding the list above can also be included but additional uses of
transrectal ultrasound would include:
1) Identifying the current stage of the mare’s estrous cycle.
2) Identifying abnormal fluid accumulation relative to ovulation, cervical relaxation, or
relative to stage of the estrous cycle.
3) Identifying abnormal endometrial edema relative to ovulation and stage of the estrous
cycle.
4) Identifying normal progression and ovulation of ovarian follicles and formation of a
corpus luteum.
5) Facilitating fluid evaluation from the uterus with manual manipulation.
6) Identifying abnormal air, debris, fluid in the vagina, vestibule, or uterus that would
warrant surgical correction or treatment depending on what and when it is identified.

REFERENCES

1) McKinnon AO (2011). Origin and Outcome of Twin Pregnancies. McKinnon, A.O.,


Squires, E.L., Vaala, W.E., Varner, D.D. Equine Reproduction, 2nd Edition. Wiley
Blackwell, West Sussex, United Kingdom. Pg 2350.
2) Ginther OJ (1992) Reproduction and Biology of the Mare: Basic and Applied Aspects.
2nd edition. Equiservices, Cross Plains, Wisconsin, USA.
3) Schnobrich MR, Riddle WT, Stromberg AJ, LeBlanc MM (2013) factors affecting live
foal rates of Thoroughbred mares that undergo manual twin elimination. Eq. Vet J. Nov;
45(6):676-80.
4) Troedsson MHT and Macpherson ML (2011) Placentitis. McKinnon, A.O., Squires, E.L.,
Vaala, W.E., Varner, D.D. Equine Reproduction, 2nd Edition. Wiley Blackwell, West
Sussex, United Kingdom. Pg 2359.