History
A 10-year-old pregnant pluriparous Ragusano jenny was presented for reluctance to move and inappetence. On clinical examination, the animal was depressed but in a good nutritional state (body condition score 3/5), presenting a ventral distension of the abdomen and a sawhorse stance (Figure 1). Heart and respiratory rates were 60 beats/min and 30 respirations/min, respectively. Mucosae appeared slightly congested, and capillary refill time was > 2 seconds. At rectal palpation and transrectal ultrasound examination (Sonosite M-Turbo; FUJIFILM Sonosite Europe), pregnancy was estimated around term (exact date of natural cover unknown) with a combined thickness of uterus and placenta of 15 mm and a live foal in cranial presentation; however, it was not possible to confirm twin pregnancy during examination. Abdominal assessment revealed severe ventral edema extending from the xyphoid cartilage to the udder, which was pushed forward cranially and showed a hemorrhagic secretion.
A—Lordosis and sawhorse stance in a Ragusano jenny with suspected prepubic tendon rupture. B—Severe ventral edema extending from the udder to the xyphoid cartilage. C—Udder pulled forward cranially.
Citation: Journal of the American Veterinary Medical Association 260, 14; 10.2460/javma.22.05.0220
Question
What are the key differential diagnoses that could have caused the abnormalities of the abdominal wall in this jenny?
Answer
The differential diagnoses for ventral distension of the abdomen in pregnant equids at full-term gestation should include gastrointestinal disorders (ie, gaseous distension) and specific conditions or diseases of pregnancy causing abdominal wall tearing or prepubic tendon (PPT) rupture (ie, twins, fetal giants, hydrops allantoid/hydrops amnion).
Results
Based on clinical presentation, particularly the udder position and hemorrhagic secretion, together with typical lordosis and sawhorse stance, a presumptive diagnosis of PPT rupture was made, since the excessive edema did not allow us to determine the site and extent of the rupture by transabdominal ultrasound.
The jenny was treated conservatively with stall rest and flunixin meglumine (1.1 mg/kg, IV, q 12 h). An abdominal band was placed to support the abdominal wall, but it was removed a few hours later since the jenny showed mild signs of discomfort (flank watching and abdomen kicking). After 7 days of therapy, the jenny was anorexic, showing mild signs of colic and recumbency without marked improvement. Since parturition was imminent based on relaxation of pelvic muscles, ligaments, and vulva, the decision to induce parturition was made to avoid any further decline in the jenny’s condition. The jenny delivered live and clinically healthy twin colts (Figure 2). Because of the hemorrhagic secretion from the dam’s udder, both foals received 1 L of hyperimmune plasma within the first 3 hours after they were born, and they were fed with mare’s milk replacer during the first 5 months of life.
Newborn twins of Ragusano donkey foals.
Citation: Journal of the American Veterinary Medical Association 260, 14; 10.2460/javma.22.05.0220
Discussion
To the best of the authors’ knowledge, the case herein described represents the first description of PPT rupture in a pregnant jenny. Similar cases have been seldom described in mares, mainly in older and multiparous animals rather than in maidens.1 As in horses, PPT rupture in donkeys might come after conditions characterized by consistent increase in abdominal weight such as hydrops allantois, hydrops amnion, fetal giants, or twins.2 In the present case, the cause of PPT rupture has been identified as twin pregnancy. In light of this evidence, the reduction of twin pregnancy to single pregnancy in jennies can be recommended, as for mares.3 If embryo squeezing is not feasible, gestational age and embryos’ or fetuses’ survival chances should be assessed prior to performing twin pregnancy reduction. In the case of late-term twin pregnancy, monitoring and assisting the dam until delivery could be an alternative to performing pharmacological abortion. Veterinary monitoring of early gestation and regular controls of jennies that are late in pregnancy are essential to ensure animal welfare and a proper management of donkey farms. Transabdominal ultrasound can represent a useful tool for definitive diagnosis, but excessive edema can limit its effectiveness, as in the present case.4 Veterinarians should rely on clinical signs (abdominal pain and colic), history, and their own experience to diagnose PPT. Twinning represents the main cause of both early (72.6%) and late (64.5%) abortion in donkeys.5 Even when a twin pregnancy comes to term, the outcome is often unfavorable for the jenny and foals despite prompt veterinary intervention. In the present case, ultrasound monitoring during early pregnancy would have highlighted the twins in advance, thus allowing proper twin reduction and possibly preventing PPT rupture.2
Outcome
Two hours following parturition, no progress in passing the placentas was observed. Two doses of oxytocin (20 IU, IM) were administered 3 hours apart before umbilical vessels were catheterized to resolve placental retention. After retained placentas were removed, oxytocin administration was maintained (20 IU, IM, q 6 h), and antimicrobial therapy was started with ceftiofur sodium (2.2 mg/kg, IM, q 24 h) to avoid the development of postpartum metritis. Despite prompt therapeutic intervention, the jenny started showing clinical signs of laminitis; therefore, flunixin meglumine (1.1 mg/kg, IV, q 12 h) and omeprazole (4 mg/kg, PO, q 24 h) were added to existing therapy, and corrective shoeing was performed. Notwithstanding medical treatment, clinical conditions worsened, and the animal was euthanized 2 weeks after parturition. Veterinary intervention was required only after the onset of clinical signs due to PPT rupture. Despite the birth of 2 healthy foals, the fatal outcome for the jenny highlights the importance of veterinary monitoring during gestation to enhance the farming system for donkeys.
Acknowledgments
No third-party funding or support was received in connection with this study or the writing or publication of the manuscript. The authors declare that there were no conflicts of interest.
References
- 1. ↑
Jalim SL. Prepubic tendon rupture in the mare. Equine Vet Educ. 2020;32(1):39–45. doi:10.1111/eve.12922
- 2. ↑
Schutten KJV. Successful foaling by a Standardbred mare with a ruptured prepubic tendon. Can Vet J. 2016;57(12):1287.
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Macpherson ML, Reimer JM. Twin reduction in the mare: current options. Anim Reprod Sci. 2000;60-61:233–244. doi:10.1016/S0378-4320(00)00112-3
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Ross J, Palmer JE, Wilkins PA. Body wall tears during late pregnancy in mares: 13 cases (1995–2006). J Am Vet Med Assoc. 2008;232(2):257–261.
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Wang Y, Wang T, Zhang Z, Wang C. Survival rate of donkey foals: status quo and improvement methods. Afr J Biotechnol. 2021;20(8):340–348. doi:10.5897/AJB2021.17376
