Placentitis & Red Bag

I have a mare that was bred on March 29, 2012. She is now 277 days. She started to develop a bag on December 20. Had the vet come out to ultrasound on December 22 and found a thickened placenta. Measured @ 1.4. Put her on Regumate 20cc SID, one initial shot of Banamine, an RHE drug for promotion of blood flow to placenta, and SMZ’s BID. Had the vet come back out today and the placenta thickness measured at 1.67. There now appears to be placental separation. Her bag has formed more on the posterior rather than the anterior area. There has not been any vaginal discharge. She will be sent to the hospital in the next week for close observation. So far no waxing. The vet did not see any indication of foaling in the next few days.

My questions are has anyone has a positive outcome with an experience like this? Is there anything else I could be doing? With the antibiotics not helping her bag go down, it seems to be indicative that the issue is with the foal? Should I expect a red bag? I would love to hear any stories similar to mine, positive or negative. TIA

So sorry you are going through this.

My one suggestion would be to continue giving the banamine everyday, vs. just the one time dose.

I have had 3 of my own mares over the years develop placentitis. Two of those went on to have live foals that did survive, and one ended up aborting around 9 1/2 months gestation. Sometimes even with the best of treatment the outcome is not positive. With my two mares that did produce live foals, neither one was a red-bag. The mare that aborted did have a red-bag “delivery”. There is no way to predict whether there will be a red-bag delivery and we always reccomend to our clients that these mares be monitored very closely, as if they abort prior to their “due date” there can often be a dystocia that is dangerous for the mare. If they make it close to a viable aged foal (around 300 days) then I would urge you to have her at a foaling facility that can provide neonatal intensive care, as often these foals have issues at birth. With one of my foals she was small and weak and had to be tube-fed and helped to rise for the first 2-3 days. The other foal was born totally normal.

I also wanted to add that although SMZs are often the first line of antibiotic defense in these cases, I have had mares that continued to have vaginal discharge or increasing vaginal discharge and placental thickening while on the SMZs. In those cases we have had exceptional success with ciprofloxacin and probenicid through BET Pharmacy. It is an initial two week course and then we either continued with it or went back to the SMZs. In my personal mare that ended up having a weak foal that survived I really credit that treatment with the survival. While using the SMZs she had increasing vaginal discharge and increasing placental thickening, but after the Cipro/Probenicid the vaginal discharge stopped the placenta did not thicken anymore. I would definitely speak to your vet about it.

My mare had similar symptoms at around day 312. In addition to SMZ’s she was also put on Regumate. She held on until day 322. It was a red bag delivery. The placenta looked horrible, dry and crusty in some areas, gooey and slimy in others. The foal was small, a rack of bones, covered in goo and dysmature. Surprisingly he was very healthy, great IgG. He had to stay in a stall for two months so his cuboidal bones could ossify.
He is now three years old, tough as nails, never been sick a day in his life, is 16.2 and growing !
This is what he looks like now:

http://www.sporthorse-data.com/d?showpic=10644228&time=1353615772

and

https://www.youtube.com/watch?v=XbjyyudA1f0

Good luck, I hope your outcome is as good as mine !

Similar to what Hillside said, my vet injected my mare with a couple different IV antibiotics over the course of a couple days, as well as starting her on oral SMZ, plus Regumate to help close the cervix and daily Banamine for at least 7 days. Regumate also seems to have a calming influence on the uterus.

For my particular mare, since her placentitis started at around day 240, we then gave her another course of 7-day SMZ at day 270 and a third course starting day 300. We also kept my mare on Regumate right through to day 310 and then started a slow wean. We weren’t finished the wean before she delivered on day 323, a live colt. For her, because her placenta wasn’t hugely thickened and coarse, we opted not to go with pentoxifylline.

With a really thickened placenta, you should discuss with your vet to consider starting her on pentoxifylline as it promotes increased blood flow (and thus nutrients) to the area and has good penetration of the placental structure. Both SMZ (also known as TMS) and pentoxifylline have good fetal penetration too.

In cases with severe placentitis, the infection spreads to the fetus, so it is important to make sure your vet uses a multi-faceted approach - using drugs that penetrate the placental infection, but simultaneously using drugs that can penetrate and treat the unborn fetus too.

Many jingles for a happy outcome.

Here was an intensive study done a few years ago:

http://www.fvmace.org/FAEP%20PES%20Conference/macpherson_Treatment%20of%20Placentitis.html

I have a mare in foal right now who tends to get chronic ascending placentitis. We started prophylactic SMZ treatment starting month 5 and she will continue to get 7-day courses each month from here on out to delivery. We also have this mare on Omega-3 not only for the antiinflammatory effect, but also the theory that Omega-3 improves system-wide vascularity and blood flow. She will be taken off the Omega-3 when she’s about 2 weeks out from foaling to reduce any bleeding risk.

You should note, there is a difference between ASA - an anti-clotting agent, and a vascular improvement drug such as pentoxifylline. In the case of placentitis, I would choose pentoxifylline over ASA.

We have an older mare that has had some degree of separation and thickening in all three of her last pregnancies. The first pregnancy we had her for, her 7th I believe, we did not have her in regulate for the first part part if the pregnancy, mostly due to some bad vet advice from a previous vet, and to us being green and not knowing any better. Our mare had a cervical repair early in the season that she was bred for that foal, and was bred late in the season. We also had to pinch as she conceived triplets (also normal for her). As soon as we found the separation at about 5 months, we stuck her on 20ml regumate daily, and I believe SMZ’S, for a two week course. The old vet never suggested continue care. He also talked us into a c-section, as we were told that the greatest chance of survival for both mare and foal was to do one. She was at the clinic nearly a month In total, including the two weeks that her foal survived. He was born septic, and despite all efforts, his joints became badly effected. He had joint flushes, almost daily, and had a herniated umbilicus repaired as well as sx for an intersuception (sp?). We lost him after a valiant struggle to survive. He was an absolutely perfect foal, just 3 weeks pre mature, and unable to stay healthy. This was in 2007.

We waited to breed her back until 2009

Her second foal with us was 3 years later, in 2010. We proactively put her on 20ml regumate, daily. We again had to pinch triplets. We do monthly scans on this mare, as she has had a troubled breeding history prior to us. She was fine until about 6 months, when we found thickening and separation, both rather significant. She immediately went on Doxycycline suspension 5 days out of every month for the remainder of the pregnancy, as well as continuing with the regumate and monthly scans. I believe we did one or two days of banamine as well. She foaled two weeks past full term, in the field, middle of the day. Easy foaling, no red bag. her placebta was horrible looking however. The resulting foal was actually born 2 weeks late, and was TINY. She was perfectly normal otherwise. We ran plasma just to be safe, but she has had zero issues. She is now 2, and in race training. Other that being only 14.3, she is perfect in every other way.

We re bred in 2010 with foal at side, and the mare did not take.

In 2011 we bred back, first cover, twins, re absorbed after pinching.

Second cover, conceived triplets. Carried one filly, after pinching two others.

This pregnancy was to be her last from the get go, as she’s an older mare with obvious issues. She did fabulous, on regumate 20ml daily, and proactively giving the doxycycline suspension 5 days out of every month. We still did scans monthly. At about month 9 1/2 months, we noticed discharge and did another scan. Big time separation (especially considering we had just scanned two weeks prior) and mild thickening. We kept up her regumate, and doxy, and added aspirin daily as well as SMZ’S twice daily. Norma was born at 10 months, 3 weeks. Officially 2 weeks early. Muscles foaled standing up, a partial red bag. We had to work really hard to get poor tiny Norma out. She was slow after foaling and required assistance getting up for the first three days. We had to physically help her get up, then let her nurse. She would finally plop herself down when she got tired of standing. After three days she lost her suckle reflex, and had to be tube fed. This lasted a few days, as the meds she was on helped to bring down any brain swelling that might be causing her issues. She was a very sick foal for the first two weeks. But, we were able to avoid a trip to the clinic. We have a fabulous vet, who worked hard to save our little girl. Once we turned the corner, however, she thrived! She is now a very pushy (just like mom) weanling, who thinks very highly of herself. She likes her belly rubbed, and her bag scratched. And like her older sister, is a short, but stellar looking individual. Muscles is now retired officially. She’s a grand old lady who has given us three lovely foals. Her two surviving foals, both fillies, will have lifetime homes with us (as will their dam), and will hopefully be broodmares for us in the future.

All this to say…

There is hope. But, this has got to be treated aggressively, and quickly. Ask about Doxycycline suspension. It’s easy, and was our saving grace. SMZ’S aren’t always the most effective in certain situations. Also ask about aspirin. It is seriously stressful trying to keep a mare pregnant once you know here are issues, but it can be done successfully. Continue to monitor via ultrasound for changes, and think good thought. I would do a course of antibiotics 5-7 days out of every month here on out. Hope this helps!

Ps Sorry for any typos, I’m typing from an iPhone, while on a car trip. Not the most conducive to correct spelling (and often leads to very odd auto corrects)

There definitely have been happy outcomes to this scenario but you never get a chance to relax until a healthy foal is up and nursing. I agree that antibiotics and banamine need to be a part of the mix.

I had a 20 year old mare develop placentitis at 7 mo. We put her on Banamine (oral), double dose of Regumate, and Naxcel. We got her symptoms under control. Symptoms came and went and we ended up doing a five day course of Naxcel once a month. She carried full term and did have a red bag delivery. The foal was very large, but healthy. We had two vets on the scene so the delivery went well. It would not have had a good outcome if not for the vet intervention. I can not emphasize enough, if the mare does fine and carries her foal, make sure she foals under veterinary supervision, at the clinic. This mare had two subsequent pregnancies with no problems.

A second mare of mine had a bout and we caught it, treated it and she was fine. No problems with that delivery and foal was normal.

[QUOTE=HilaryHrsRdr;6754250]
I have a mare that was bred on March 29, 2012. She is now 277 days. She started to develop a bag on December 20. Had the vet come out to ultrasound on December 22 and found a thickened placenta. Measured @ 1.4. Put her on Regumate 20cc SID, one initial shot of Banamine, an RHE drug for promotion of blood flow to placenta, and SMZ’s BID. Had the vet come back out today and the placenta thickness measured at 1.67. There now appears to be placental separation. Her bag has formed more on the posterior rather than the anterior area. There has not been any vaginal discharge. She will be sent to the hospital in the next week for close observation. So far no waxing. The vet did not see any indication of foaling in the next few days.

My questions are has anyone has a positive outcome with an experience like this? Is there anything else I could be doing? With the antibiotics not helping her bag go down, it seems to be indicative that the issue is with the foal? Should I expect a red bag? I would love to hear any stories similar to mine, positive or negative. TIA[/QUOTE]

I have had 3 cases of placentitis (same mare all 3 times) and foal survived 2 of 3 times. The first one did not as it was not expected and the foaling attendant (did not foal out at my farm/person on foalwatch had fallen asleep/missed the foaling at the worst possible time). Mare had a RB and foal did not make it. The other 2 times the mare foaled out at the vets place once …RB and foal did survive: we were due to go on vacation when mare was due so she got parked at the vets to foal out…and third and very last time no RB and foal was a normal delivery.After 3 placentitis foals (mega aggressive treatment by the third one…) she got retired from breeding.So…I would plan for the worst (RB) and hope for the best. Do NOT let her foal out unattended. FWIW the vet cultured the placenta on RB on the one that foaled at his place. She had a fungal infection…so the SMZs did squat.

The only thing I can say (because I have no experience) is I will keep my fingers crossed that everything goes according to plan for your mare!