1. Fetal Monitoring in High Risk Pregnancies
My research and presentation topic
By: Laura Killian

2. What is normal? Heart beat at 25 days
Heart rate before 330 days gestation: bpm
Heart rate after 330 days gestation: bpm
Heart rate variations from bpm
More active than human babies
20 complex movements per hour
Dormant up to 10 minutes
Calm periods for minutes
Maximum amniotic fluid depth cm, averaging 7.9cm
Maximum allantoic fluid depth cm, averaging 13.4cm
Aortic diameter averages 22.8mm
Uteroplacental thickness of 7-13mm, averaging 11.5mm
First must establish what is normal in order to recognize complications and abnormalities
For example, heart rate:
As low as 40 bpm at rest or when maximizing efficiency As high as 120 bpm when active repositioning
Activity proves there is adequate oxygen supply
If heart rate is very high or low recheck in 24 hours
A very high heart rate indicates stress
Variations between extremes indicate compensation for lack of oxygen
If movement complexity of movements decreases, it may indicate impaired oxygen supply
If volume of fluid is greater, it may mean there is a fetal hemorrhage or diarrhea
If diameter is small, it may mean inadequate nutrient and oxygen to support growth and development
If thicker, may indicate placentitis

3. High Risk Pregnancy Defined:
“A mare that has had a septic foal in the past, or a dystocia, or has had a history of premature placental separation or red bag”
What is a high risk pregnancy?

4. Perinatology Defined:
“Care of the mother and fetus during pregnancy, labor, delivery, and early neonatal period, particularly when the mother and/or fetus are at high risk for complications”
What is a high risk pregnancy?

5. Why fetal Monitoring? Check physiological signs for normal development
Indicate that a problem has arisen and asses severity
Address issues before they become too serious
Monitor response to treatment
Decrease the chance of abortion or death of foal
Decrease chance of injury or death of mare
Why is it important?
Cover more in depth during upcoming slides

6. Fetal Biophysical Profile
Humans
Horses
Fetal Heart Rate
Body Movement
Amniotic Fluid
Breathing
Body Tone
Fetal Heart Rate
Fetal Activity
Amniotic Fluid
Allantoic Fluid
Fetal Aortic Diameter
Placenta Thickness
Uteroplacental Contact
Check physiological signs for normal development
No scale for biophysical profile in horses, like in humans although studies have created guides for measurement
Set factors typically observed, but not precise and standard calculation of risk
Heart rate shows stress and movement
Activity indicated adequate oxygen and use of central nervous system
Fluid volume shows fluid formation and excretion proving oxygen sufficiency.
Aortic diameter predicts final size of foal
Placenta thickening indicating potential infection
Uteroplacental contact shows effectiveness of nutrient transfer from mare to fetus

7. When to closely monitor
Previous Pregnancies
Current Pregnancy
Red bags
Dystocia
abortion
Premature foaling
Prolonged pregnancy
Uterine hemorrhage
Neonatal isoerythrolysis
Retained placenta
Lack of milk production
placentitis
Twins
illness
weight loss
Surgery
Anesthesia
stress
Grazing on tall fescue
Infection
Vaginal discharge
Fever
Umbilical torsion
Prevalence of problem and need for advancement
Numerous reasons why a mare would be high risk and need careful assessment and monitoring
Must check physiological signs for normal development in current pregnancy to find potential issues
Total number of high risk mares not available because of the variances between level of severity and numerous causes
Birthing complications are the second most common cause of fetal loss

8. Foalert System Sutured onto mare’s vulva
Signal transmitted to indicate parturition
Does not require veterinarian
Enables assistant to monitor delivery
All of the following techniques and technology decrease the chance of abortion or death of foal and/or injury or death in the mare
Foalert is a simple way to inform attendants of foaling so someone is present in case of complications

9. Hormone Levels Less sensitive than ultrasound
Blood samplings check progesterone and estrogen levels
High progesterone in the mid-stage of pregnancy may indicate placentitis, stress or other complications
Low estrogen levels indicate the fetus may not be viable
Numerous samples must be taken throughout the pregnancy to accurately assess risk
Progesterone levels and estrogen levels may indicate issues maintain the pregnancy or carrying to term

10. Ultrasonography Used in early pregnancy Used after 90 days
Rectal
Abdominal
Used in early pregnancy
Tightness of cervix
Position on foal
Size of uterus
Movement of foal
Used after 90 days
Heart rate patterns
Umbilical chord
Amniotic fluid
Fetal aorta
Detects heart beat in early ultrasound
Shows changes of position, indication viability and health of foal
After 90 days, the foal descends further into the abdomen
Heart Rate data is more details with abdominal ultrasound
Umbilical chords are the nutrient link between the mare and fetus
Amniotic fluid (cups???)
Fetal aorta size can be used to estimate foals overall size

11. Doppler Monitor Attached to the exterior of the mare’s abdomen
Tracks fetal movement and heart rate
Keeps record of variations for several hours at a time
Give more accurate minute by minute changes and patterns in heart rate
Not used except in animal hospitals with round the clock monitoring despite that it is inexpensive and simple

12. Intranasal Oxygen Foal oxygen therapy Maternal oxygen therapy
Foals receptors can be damaged an unresponsive to the low levels of oxygen
Other foals are too weak or fatigued to respond to lack of oxygen
The last type of foal to receive this therapy has upper airway obstruction
In mares, the oxygen therapy is given to support the fetus when lacking intake

13. Effectiveness Neonatal Intensive Care Unit at New Bolton Center
2053 cases
84% success rate
8-10% of broodmares lose their pregnancy before term
“Vast numbers of normal pregnancies can lull us into a false sense of security”
Diagnosis for success
High risk pregnancies happen for many reasons, but still are not occurring extremely frequently
If issues are detected early, the pregnancy can typically be stabilized
With current technology available, veterinary hospitals have a high success rate in saving the mares and foals

14. Services and Fees Standard Ultrasounds examinations ($50-$65/exam)
Monitoring, medication and evaluations (additional fee)
Pregnant Mare boarding ($20-$30/day)
Broodmare Monitoring ($500-$750/foaling)
Doppler Monitoring (rentals for $20-$50/month)
High Risk Pregnant Mare Program (price not disclosed)
Cesarean section ($3000+/operation)
Places where it’s done/price
Ultrasounds are used to check pregnancy status, twinning and development
Monitoring may be needed if the mare has had previous complications
Medication may be needed to regulate hormone levels (progesterone)
Additional evaluations may be made if the heart rate is at an extreme
Daily monitoring is done through in-stall cameras and post-natal care provided
Doppler monitors tracks changes in heart rate and movement
Mare programs provide round the clock monitoring, surgical stall and advanced monitoring and examination equipment
Emergency C sections can save the mare and foal

15. Questions?