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Monday, September 29, 2008

Managing Twins in the Mare

C. Scott Bailey, DVM, Dipl. ACT

Although twinning in the horse is a well-described condition academically, it remains a topic for which most horse-owners and many veterinarians feel inadequately prepared. Historically, twinning has been the most common cause of mid- to late-term pregnancy loss in mares; this is because the equine placenta requires a large surface area (the entire uterus) to supply sufficient oxygen and nutrients to the developing fetus in late gestation. Even a relatively small decrease in surface area will result in growth- retardation and a smaller and less thrifty foal at birth.

Physiologically, twins are most often the product of 2 asynchronous ovulations in a single cycle, which may be up to 5 days apart in the mare. For the first 16 days both developing embryos will be propelled around the uterus either adjacent to each other or separately, and they will then become fixed by muscular contraction between 16 and 17 days. In 80% of cases, the embryos are fixed together at the base of one horn, and in 20% of cases, they are each fixed in separate horns. In the latter case, there is no competition for nutrients in early gestation and the vast majority of cases result in late-term abortion. However, if the embryos are adjacent to each other, they may undergo spontaneous regression (70%) by day 40. Overall, in one study 64% of naturally occurring twins were found to undergo spontaneous regression, most before day 26. The likelihood of spontaneous reduction decreased thereafter until day 40. After day 40, 90% of twins will result in late-term pregnancy failure, either in the form of abortion of both fetuses, stillbirth and stunting of term foals or dystocia.

Despite the high rate of pregnancy failure in mares carrying twins, the incidence of double-ovulations is high (20%) is some breeds. The very act of reducing twins results in increased numbers of horses that carry the genetic propensity for twinning. Likewise, inducing ovulation with exogenous hormones also increases the likelihood of double-ovulations. As a result, the use of ultrasound for early pregnancy diagnosis has become routine for many equine practitioners. At this stage, reduction of pregnancy by “pinching” one embryonic vesicle can be performed reliably and safely. This procedure is generally performed around 14-15 days of gestation – a time at which embryonic vesicles are readily detectable and are still mobile in the uterus, making it possible to move one embryo to the tip of a horn by manual trans-rectal manipulation. Once the vesicle is separated adequately from the remaining embryo, and is at the tip of a horn it can be “pinched” manually or with the ultrasound. This procedure has a 90-95% success-rate when performed by a skilled practitioner and can be performed early in pregnancy, at a time in which re-breeding the mare is possible if the procedure results in the loss of both embryos.

After this critical window, success-rates for various reduction methods are low. Between 17 and 26 days natural reduction with or without the benefit of energy deprivation by eliminating grain-based feed may be the most effective means of eliminating one twin. However, if twins are still identified after day 30, another means of reduction should be selected. Allowing the pregnancy to continue beyond day 35 will result in the development of endometrial cups and a loss of the remaining-breeding season if pregnancy is lost subsequently. Therefore, trans-vaginal ultrasound-guided twin reduction may be attempted at this time. A 5 - 7.5 MHz vaginal ultrasound probe with a needle-guide is used to visualize one embryo, which is held adjacent to the probe with one hand in the rectum. The needle is then punctured through the vaginal wall and uterus, and the fetal fluids are aspirated aggressively. This technique has been reported with a 30% success-rate for the production of one live foal in the case of unilateral twins, and up to 70% success-rate for the production of one live foal in the case of bilateral twins when performed between 30 and 36 days.

After 35-36 days of pregnancy, two procedures have been described for selective reduction of one twin.

Most recently, cranio-cervical dislocation of one fetus has been described by a practitioner in central Kentucky. While not widely available, this technique has been demonstrated to carry a relatively high success-rate of >60%. It can be performed trans-rectally or surgically by flank laparotomy, and has been described between 60 and 110 days. At this stage of gestation, the gender of each fetus can be determined, and the fetus is selected for reduction based on both gender and location in the uterus. In addition, this procedure can be performed before complete development of the placenta and may have a higher success-rate than later procedures due to the ability of the remaining fetus to form a fully functional placenta.

Alternatively, ultrasound-guided trans-abdominal cardiac puncture has been well-described in the literature, with a success-rate around 50%. For this procedure, the fetuses are identified by trans-abdominal ultrasound after sedation of the mare and one fetus is injected with KCl or procaine penicillin by intra-cardiac puncture using a spinal needle. The success of this procedure is operator-dependent, but is less invasive than the surgical procedure described above and requires little equipment other than a 3.5 MHz curvilinear probe. It is best performed between 115 and 130 days of gestation and as for the procedure above, both location and fetal gender may be used as criteria for selection. It should be noted that this procedure may result in the birth of a small and unthrifty foal. This is likely due to the fact that the placenta is largely developed by 120 days and the area of placenta which opposes that of the reduced twin remains unavailable for nutrient transfer for the remainder of gestation.

When all other procedures fail to achieve the goal of one developing fetus, abortion of both conceptuses is the single remaining option. Due to the risk of dystocia and periparturient complications to the mare and the low chance of achieving two live foals (1- 2%), allowing the pregnancy to be maintained naturally cannot be recommended. Chemical abortion can easily be achieved before formation of the endometrial cups (36-40 days) with a single dose of prostaglandin or prostaglandin analog, but may require multiple doses of a prostaglandin/ prostaglandin analog and/or oxytocin in later gestation. At this time, abortion should be performed in a hospital-setting, where the mare can be monitored carefully and where parturition can be attended.

Thus, while twins undoubtedly constitute a significant risk to equine pregnancy, there are many methods of managing them successfully. Indeed, the common use of ultrasound for early pregnancy diagnosis has been so successful that many practitioners now feel that double-ovulations are actually of benefit, because they increase the likelihood of fertilization and because any twins can readily be managed early in gestation.


Ginther OJ. Twin embryos in the mare: 1. From ovulation to fixation. Equine Vet J 1989; 21:166-70

Leadon DP, Rossdale PD, Jeffcot LB et al. A comparison of agents for inducing parturition in mares in the pre-viable and premature periods of gestation. J Reprod Fertil Suppl 1982; 32: 597-602

Macpherson ML, Homco LD, Varner DD. Transvaginal ultrasound-guided allantocentesis for pregnancy elimination in the mare Biol Reprod Monogr 1995; 1: 215-223

Rantanen NW, Kincaid B. Ultrasound guided fetal cardiac puncture. A method of twin reduction in the mare. Proc Am Assoc Equine Pract 1988; 34:173-79

Wolfsdorf KE. Management of postfixation Twins in Mares. Vet Clin Equine 2006; 22: 713-725

Practical Recent Abstracts

Edited by Jennifer S. Fryer, DVM

The influence of crystalloid type on acid-base and electrolyte status of cats with urethral obstruction

Drobatz KJ, Cole SG. JVECCS 2008; 18: 355 – 361.

To compare the effect of a balanced isotonic crystalloid solution with that of 0.9% sodium chloride on the acid[ndash]base and electrolyte status of cats with urethral obstruction. Randomized prospective clinical trial. Academic veterinary emergency room.

Sixty-eight cats with naturally occurring urethral obstruction. Cats were randomized to receive either a balanced isotonic crystalloid solution (Normosol-R, n=39) or 0.9% sodium chloride (n=29) for fluid therapy. Baseline venous blood gas and blood electrolyte values were obtained at the time of admission and at intervals during the course of therapy. Baseline values were similar between groups.

Cats receiving Normosol-R had a significantly higher blood pH at 12 hours, a significantly greater increase in blood pH from baseline at 6 and 12 hours, as well as a significantly higher blood bicarbonate concentration at 12 hours and a significantly greater increase in blood bicarbonate from baseline at 6 and 12 hours. Conversely, the increase in blood chloride from baseline was significantly higher at 2, 6, and 12 hours in cats receiving 0.9% sodium chloride. There were no significant differences in the rate of decline of blood potassium from baseline between groups. Subgroup analysis of hyperkalemic cats (K+>6.0 mmol/L) and acidemic cats (pH<7.3) style="font-weight: bold;">Efficacy and tolerability of once-daily cephalexin in canine superficial pyoderma: an open controlled study

Toma S, Colombo S, Cornegliani L, Persico P, Galzerano M, Gianino MM, Noli C. Journal of Small Animal Practice 2008; 49: 384 – 39.

Objectives: The aims of this study were to evaluate the efficacy and tolerability of oral cephalexin given at 30 mg/kg once daily in dogs with superficial pyoderma and to compare them with those of oral cephalexin given at 15 mg/kg twice daily.

Methods: Twenty dogs with superficial pyoderma were treated with cephalexin at 30 to 60 mg/kg orally once daily (group A) and compared with 20 dogs treated at a dose of 15 to 30 mg/kg orally twice daily (group B). Dogs were treated until 14 days after clinical remission. Type and distribution of lesions, pruritus and general health status were assessed every 14 days using a numerical scale until 14 days after treatment discontinuation. Total scores for each evaluation day were compared between the two groups as well as time to obtain resolution and percentage of relapses.

Results: Resolution of superficial pyoderma was obtained in all dogs in 14 to 42 days (median 28 days for both groups), with no difference between groups. Six dogs experienced vomiting or diarrhoea but did not require discontinuation of the treatment. Only one dog (in group A) relapsed nine days after treatment discontinuation.
Clinical Significance: Once-daily cephalexin is as effective as twice-daily cephalexin in the treatment of canine superficial pyoderma.

Evaluation of antibodies against feline coronavirus 7b protein for diagnosis of feline infectious peritonitis in cats

Kennedy MA, Abd-Eldaim M, Zika SE, Mankin JM, Kania SA. AJVR 2008; 69: 1179-1182.

Objective—To determine whether expression of feline coronavirus (FCoV) 7b protein, as indicated by the presence of specific serum antibodies, consistently correlated with occurrence of feline infectious peritonitis (FIP) in cats.

Sample Population—95 serum samples submitted for various diagnostic assays and 20 samples from specific-pathogen–free cats tested as negative control samples.

Procedures—The 7b gene from a virulent strain of FCoV was cloned into a protein expression vector. The resultant recombinant protein was produced and used in antibody detection assays via western blot analysis of serum samples. Results were compared with those of an immunofluorescence assay (IFA) for FCoV-specific antibody and correlated with health status.

Results—Healthy IFA-seronegative cats were seronegative for antibodies against the 7b protein. Some healthy cats with detectable FCoV-specific antibodies as determined via IFA were seronegative for antibodies against the 7b protein. Serum from cats with FIP had antibodies against the 7b protein, including cats with negative results via conventional IFA. However, some healthy cats, as well as cats with conditions other than FIP that were seropositive to FCoV via IFA, were also seropositive for the 7b protein.

Conclusions and Clinical Relevance—Expression of the 7b protein, as indicated by detection of antibodies against the protein, was found in most FCoV-infected cats. Seropositivity for this protein was not specific for the FCoV virulent biotype or a diagnosis of FIP.