Case Report: Diagnosis and treatment of equine ascending placentitis: compilation of 17 case reports.
Authors: Hemberg Elisabeth, Morrell Jane M
Journal: Frontiers in veterinary science
Summary
# Editorial Summary: Managing Equine Ascending Placentitis Ascending placentitis—infection of the placenta via the vulva during late pregnancy—represents a significant reproductive emergency, with treatment timing and approach critically influencing whether mares deliver healthy or compromised foals. This 13-year retrospective case series examined 17 mares presenting with classic signs of placentitis (premature udder development and/or vulval discharge) to identify optimal diagnostic and therapeutic protocols. All mares were retained in pregnancy and delivered live foals; however, outcomes varied markedly between early and late cases, with mares treated in earlier stages producing septicaemic neonates despite intervention, whereas later presentations—managed with trimethoprim-sulphonamide twice daily combined with twice-daily acetylsalicylic acid until foaling—yielded foals with minimal or absent clinical signs. Vulvoplasty (Caslick's procedure) was performed in 16 mares, either initially or as an extension of existing surgery, emphasising that anatomical correction to restore vulval competence must accompany antimicrobial and anti-inflammatory therapy. For equine practitioners, these findings underscore the importance of recognising early warning signs and implementing multimodal treatment—combining antimicrobials with good placental penetration, COX-1 inhibition to preserve placental perfusion, and vulval surgical correction—to optimise foal viability and neonatal health outcomes.
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Practical Takeaways
- •Early recognition of placentitis signs (premature udder activity, vulvar discharge) and prompt treatment with drugs that achieve good uterine perfusion significantly improves foal survival and health outcomes
- •Combining antibiotic therapy (trimethoprim sulphate) with anti-inflammatory medication (acetylsalicylic acid) and vulvoplasty appears effective for managing ascending placentitis through pregnancy to term
- •Timing of treatment initiation is critical—mares treated earlier with poor placental penetration had compromised foals, whereas treatment ensuring good uterine perfusion prevented foal septicaemia
Key Findings
- •All 17 mares treated for placentitis maintained pregnancy and produced live foals that survived
- •Early cases with poor placental drug perfusion resulted in septicaemic foals; later cases with improved perfusion had foals with minor or no clinical signs
- •Treatment protocol combining trimethoprim sulphate and acetylsalicylic acid twice daily until parturition with good uterine perfusion was associated with better foal outcomes
- •Vulvoplasty (Caslick's operation) performed in 16 of 17 mares as part of treatment to restore vulvar seal