Sonographic Features during Placental Development and Cardiovascular Adaptation in Pregnant Mare: two-dimensional ultrasonography, echocardiography and contrast-enhanced ultrasound (CEUS)

In corso di gravidanza normale avvengono modificazioni emodinamiche centrali e periferiche volte a garantire le crescenti richieste nutritive dell'unità feto-placentare. L’ecografia con mezzo di contrasto (CEUS-Contrast Enhanced Ultrasonography) a base di microbolle offre una nuova opportunità di monitorare e quantificare la perfusione utero-placentare in condizioni normali e patologiche. L’ecocardiografia è stata ampiamente usata in medicina umana per valutare l’adattamento morfo-funzionale cardiaco materno durante la gravidanza. Gli scopi di questo lavoro prospettico sono stati di applicare, per la prima volta nella specie equina, un mezzo di contrasto di II generazione (Sonovue®), al fine quantificare la perfusione utero-placentare in corso di gravidanza normale, valutandone gli effetti sul benessere materno-fetale e di descrivere le modificazioni nei parametri ecocardiografici morfometrici e funzionali cardiaci, in particolare relativi alla funzione del ventricolo sinistro nel corso di una gravidanza fisiologica. Due fattrici sane di razza Trottatore sono state monitorate ecograficamente in maniera seriale durante l’intero corso della gravidanza, tramite esame bidimensionale, ecocontrastografia dell'unità utero-placentare, flussimetria Doppler delle arterie uterine, ecocardiografia materna in modalità bidimensionale, M-mode, Doppler e Tissue Doppler Imaging. I neonati sono stati clinicamente monitorati e gli invogli fetali esaminati. Il pattern di microperfusione utero-placentare è valutabile quali-quantitativamente tramite la CEUS e dimostra un’aumento del flusso a livello di microvascolarizzazione uterina con l'avanzare della gravidanza; non è stata rilevata la presenza di microbolle a livello di strutture fetali nè effetti dannosi sul benessere materno-fetale. In questo studio sono state osservate delle modificazioni cardiache materne in corso di gravidanza fisiologica, relative all'aumento della FC, del CO ed in particolare all'aumento delle dimensioni dell'atrio sinistro ed a modificazioni nelle onde di velocità di flusso e tissutali di riempimento del ventricolo sinistro.During normal pregnancy central and peripherical haemodynamic changes occurr to meet the increased nutrient demand of the growing feto-placental unit. Microbubble-based contrast-enhanced ultrasound (CEUS) offers a new opportunity to monitor and quantify utero-placental perfusion in normal and abnormal pregnancy. Echocardiography have been widely used in human medicine to evaluate maternal cardiac structural and functional adaptation to pregnancy. The aims of this prospectic study were to apply for the first time a II generation sonographic contrast medium (Sonovue®) to quantify utero-placental perfusion during equine normal pregnancy, evaluating the effects on feto-placental and maternal well-being, and to describe echocardiographic changes in cardiac morphological and functional parameters, focusing on left ventricle function, during normal pregnancy in the mare. Two healthy Standardbred mares were evaluated by serial sonographic examinations during pregnancy, using two-dimensional ultrasonography, utero-placental unit contrast-enhanced ultrasound, uterine arteries Doppler and echocardiography, including two-dimensional, M-mode, Doppler and Tissue Doppler Imaging. Newborn foals and fetal membranes were also evaluated. CEUS allowed monitoring and quantification of utero-placental perfusion pattern and demonstrated an increase in uterine microcirculation blood-flow during pregnancy; no microbubbles were detected in the umbilical vein and fetal compartments and no adverse effects on fetal and maternal well-being were observed. In this study, maternal cardiac haemodynamic changes were observed during normal pregnancy, including an increase in heart rate and cardiac output, an increase in left atrium dimensions and changes in left ventricular filling flow and tissue Doppler velocity waves

Evaluation of a smartphone electrocardiograph in healthy foals and comparison to standard base-apex electrocardiography

Smartphone-based technology for ECG recording has recently spread as a complementary tool for electrocardiographic screening and monitoring in adult horses and in other animal species. The present study aimed to assess the feasibility and accuracy of a smartphone-based ECG in healthy foals. This was a prospective observational study (authorization n. 45,865/2016) including 22 foals aged less than 21 days. A reference standard base-apex ECG (rECG) was acquired, and a smartphone ECG (sECG) was recorded immediately after by using a smartphone-based single lead electrocardiograph. All ECG tracings were evaluated in a blind fashion by a single board-certified cardiologist, who judged whether the tracings were acceptable for interpretation and performed ECG measurements and diagnosis. The Spearman correlation coefficient, the Cohen's k test and the Bland-Altman test were used to assess the agreement between sECG and rECG. All sECG tracings were acceptable for interpretation. All foals showed sinus rhythm on both rRCG and sECG tracings, with perfect agreement in heart rate classification (κ = 0.87; p < 0.001). No clinically relevant differences were found in the assessment of waves and intervals duration. Concerning P wave and QRS complex polarity, the percentage of agreement between rECG and sECG was 78% and 83%, respectively. About ECG tracing quality, rECG and sECG showed a substantial agreement (κ = 0.624; p < 0.001). In conclusion, the smartphone-based ECG device tested in the present study recorded good quality single-lead ECG tracings in foals, reliable for heart rate and ECG measurements, but different polarity of P waves and QRS complexes was found in some foals in comparison to rECG

Blood Gas, Acid-Base and Electrolyte Analysis in Healthy Dromedary Camel Calves up to 21 Days of Life

: The importance of prompt evaluation and care of the newborn is essential for reducing neonatal mortality, which represents a major cause of loss in camelids. This study investigated the blood gases, acid-base and electrolyte profiles in healthy dromedary calves during the first 3 weeks of life, assessing possible associations with age. Twenty-one dromedary camel calves aged 1 to 21 days were sampled, and venous whole blood analyzed through a VETSTAT® analyzer. The following parameters were measured: sodium (Na+), potassium (K+), chloride (Cl-), hydrogen ion concentration (pH), partial pressure carbon dioxide (pCO2), partial pressure oxygen (pO2), total hemoglobin concentration (tHb), hemoglobin oxygen saturation (sO2), total carbon dioxide (tCO2), bicarbonate (HCO3-), base excess (BE) and anion gap (AG). Calves were divided in two groups; younger calves (1-10 d), and older calves (11-21 d). Statistical analysis showed an effect of age, with lower K+ (p < 0.001) and higher Na+ and Cl- (p < 0.05) mean concentrations in the younger calves compared to the older ones, and higher pCO2 and lower sO2 mean concentrations in the older group. These preliminary results firstly described the blood gas, acid-base and electrolyte profiles in the healthy dromedary calf during the first 3 weeks of age, suggesting an effect of age on some parameters

Rhabdomyolysis and Acute Renal Failure Associated with Oxytetracycline Administration in Two Neonatal Foals Affected by Flexural Limb Deformity

Oxytetracycline (OTC) administration has become a frequent practice in equine neonatology for the treatment of flexural limb deformity. The cause of this condition remains unclear but clinical studies revealed that following IV administration of OTC a relaxation of the metacarpophalangeal joint occurs in foals affected by flexural deformity. Studies concluded that OTC administration in neonatal foals did not adversely affect the kidneys. Other adverse effects of OTC have never been reported. This report presents two cases with different outcomes of 3-day-old foals which presented acute collapse and progressive depression after OTC administration. The clinical aspects, the increased activity of serum enzymes indicative of muscular damage, the presence of myoglobin in urine were clear diagnostic indicators of severe rhabdomyolysis, and the gross and histological findings confirmed a myopathy associated with renal damage in one case. Adverse effects on the musculoskeletal and urinary systems in healthy foals were first reported and were probably associated with multiple doses administered to foals less than 24\u201348 h old and/or at dosing intervals less than 24\u201348 h. The risk of development of rhabdomyolysis and nephrotoxicity in neonatal foals treated with OTC for flexural deformity from now on should be considered

Fetal Congenital Diaphragmatic Hernia and Hydramnios in a Quarter Horse Mare

open6noHydramnios is an excessive accumulation of fluid within the amniotic compartment. It is a rare condition in mares, often associated with fetal anomalies. Hydrops of fetal membranes predisposes to the rupture of the prepubic tendon, and many authors suggest the induction of parturition to preserve mare’s reproductive career. This report presents the case of a 15-year-old multiparous Quarter Horse mare, referred at 268 days of gestation for suspected hydrops. Repeated ultrasonographic exams confirmed an increase in the depth of the amniotic fluid and reduced fetal viability. During the hospitalization, the mare developed a partial rupture of the prepubic tendon. In this case, a conservative approach was elected, and the mare was treated with nonsteroidal antiinflammatory drugs (NSAIDs) and an abdominal support bandage. At 327 days of gestation, the mare gave birth to a foal with APGAR score 1. The resuscitation attempt was unsuccessful, and the foal died immediately. A post-mortem examination diagnosed a congenital diaphragmatic hernia (CDH) with pleuroperitoneal diaphragmatic eventration.openLanci, Aliai; Ingallinesi, Martina; Morini, Maria; Freccero, Francesca; Castagnetti, Carolina; Mariella, JoleLanci, Aliai; Ingallinesi, Martina; Morini, Maria; Freccero, Francesca; Castagnetti, Carolina; Mariella, Jol

Peripartum findings and blood gas analysis in newborn foals born after spontaneous or induced parturition

Induction of parturition in horses is still not well accepted due to the potential peripartum complications for mares and newborn foals. We assessed differences after spontaneous and induced parturition with low doses of oxytocin (OX) in 1) incidence of peripartum complications in mares; 2) viability, behavioral, physical, and venous blood gas analyses in foals. In this study 61 mares were included; 45/61 were enrolled in the spontaneous foaling group (SF) and 16/61 in the induced foaling group (IF). In the IF group, when the calcium in mammary secretion reached concentrations of !250 ppm, mares received a single injection of 2.5 IU of oxytocin IV once a day until foaling. Mares’ breed, age, parity, gestational and stage II length, and peripartum complications were recorded. Foal maturity, vital (Apgar score), behavioral and physical parameters were assessed at birth, and the foal clinical condition was monitored for one week. A jugular venous blood sample was collected at birth for blood gas analysis, acid-base status, and lactate assessment. The median gestational length was within the reference interval in all the mares included and did not differ between the two groups. No statistical differences in the II stage length nor in incidence of peri- partum complications were observed between the two groups. All the foals were born alive and showed no signs of prematurity/dysmaturity. No statistical differ- ences were found in foal viability between the two groups. Time to stand and nurse from the mare, and body temperature were significantly higher in the IF compared to the SF group. Venous blood pH, SO2% and BE were lower, while pCO2 and lactate were higher in the IF than in the SF group. All the foals in both groups remained clinically healthy during the observation period. In conclusion, at term induction of parturition with a low dose of oxytocin does not have adverse effects on peripartum in mares. Our findings suggest that at term induced foals suffer slightly greater, but not clinically significant, hypoxia, hypercapnia and acidosis than spontaneously delivered foals

Effects of Intra-Uterine Fluid Accumulation after Artificial Insemination on Luteal Function in Mares

After breeding or artificial insemination, especially with frozen/thawed semen, mares often develop a persistent uterine inflammation, which is diagnosed by intra-uterine fluid accumulation. Here, we explored whether intra-uterine fluid accumulation affects corpus luteum function and tested the hypothesis that intra-uterine fluid accumulation after artificial insemination alters blood flow in the corpus luteum and plasma progesterone concentrations. A total of 40 Standardbred mares were artificially inseminated with frozen-thawed semen 30 to 36 h after induction of ovulation, and cases with or without intra-uterine fluid accumulation were detected by ultrasound 12 h after insemination. Luteal blood flow was measured by Power Doppler ultrasonography 3 and 6 days after ovulation, progesterone concentration was measured in peripheral plasma by ELISA 6 days after ovulation, and pregnancy was diagnosed by ultrasonography 14 days after ovulation. Luteal blood flow increased between 3 and 6 days after ovulation, but blood flow did not differ significantly between cases with (n = 28) and without (n = 25) intra-uterine fluid accumulation after insemination. Surprisingly, progesterone concentrations were higher in cases of intra-uterine fluid accumulation than cases without (9.3 ± 1.1 vs. 6.6 ± 0.5 ng/mL, p = 0.048). Pregnancy was less likely in cases with intra-uterine fluid accumulation than in cases without (10/28 vs. 17/25, p = 0.019), and there was a negative correlation between the severity of intra-uterine fluid accumulation and per cycle pregnancy rate. These data suggest that although intra-uterine fluid accumulation increases the secretion of progesterone, pregnancy is more dependent on uterine health than ovarian function

Doppler evaluation of renal resistivity index in healthy conscious horses and donkeys.

The renal resistive index (RRI) is used as a measurement of downstream resistance in arteries. The aim of this study was to assess the RRI of the arcuate arteries by pulsed-wave Doppler ultrasonography in healthy conscious horses and donkeys, and to verify any differences related to age, breed, bodyweight (BW) or body condition (BCS). Thirty-three healthy conscious horses and nine donkeys had their systolic and diastolic flow velocities at the level of the arcuate arteries estimated by pulsed-wave Doppler ultrasound, and the RRI was calculated. The relationship of RRI with age, breed (Trotters vs. other breeds), bodyweight (BW), and body condition score (BCS) were evaluated. PW Doppler evaluation of RRI was successfully applied in most of the horses, but to date not in the donkeys. In horses, median RRI values for the right kidney (0.58±0.006) were statistically higher than for the left (0.51±0.006). For the donkeys the values were comparable. There was no significant difference in RRI between horses younger or older than 15 years, and between breeds in horses. No correlation with age, BW or BCS was found in either horses or donkeys

Effects of Intra-Uterine Fluid Accumulation after Artificial Insemination on Luteal Function in Mares

After breeding or artificial insemination, especially with frozen/thawed semen, mares often develop a persistent uterine inflammation, which is diagnosed by intra-uterine fluid accumulation. Here, we explored whether intra-uterine fluid accumulation affects corpus luteum function and tested the hypothesis that intra-uterine fluid accumulation after artificial insemination alters blood flow in the corpus luteum and plasma progesterone concentrations. A total of 40 Standardbred mares were artificially inseminated with frozen-thawed semen 30 to 36 h after induction of ovulation, and cases with or without intra-uterine fluid accumulation were detected by ultrasound 12 h after insemination. Luteal blood flow was measured by Power Doppler ultrasonography 3 and 6 days after ovulation, progesterone concentration was measured in peripheral plasma by ELISA 6 days after ovulation, and pregnancy was diagnosed by ultrasonography 14 days after ovulation. Luteal blood flow increased between 3 and 6 days after ovulation, but blood flow did not differ significantly between cases with (n = 28) and without (n = 25) intra-uterine fluid accumulation after insemination. Surprisingly, progesterone concentrations were higher in cases of intra-uterine fluid accumulation than cases without (9.3 ± 1.1 vs. 6.6 ± 0.5 ng/mL, p = 0.048). Pregnancy was less likely in cases with intra-uterine fluid accumulation than in cases without (10/28 vs. 17/25, p = 0.019), and there was a negative correlation between the severity of intra-uterine fluid accumulation and per cycle pregnancy rate. These data suggest that although intra-uterine fluid accumulation increases the secretion of progesterone, pregnancy is more dependent on uterine health than ovarian function