Section: Results of the Examination
A mare does not pass or fail a BSE, but all results are pooled together to ascertain the likelihood of a mare to become pregnant and/or carry a foal to term, and to determine whether the mare requires any specific treatment prior to breeding. Some common problems that can be diagnosed during a routine BSE include:
Pneumovagina (windsuckers). This means aspiration of air into the vagina, which usually continues into the uterus, predisposing the mare to vaginal and uterine inflammation and infections. It is usually due to incompetence of the vestibulo-vaginal sphincter and/or poor vulvar conformation. This is surgically treated, most commonly by suturing about two thirds of the length of the vulvar lips together (Caslick's operation or episioplasty). Do not forget that all mares with a Caslick's in place must be opened for breeding and especially prior to foaling.
Urovagina or urine pooling. This means accumulation of urine in the vagina of the mare, usually associated with poor conformation and/or pneumovagina. It can also be the result of previous foaling injuries affecting the reproductive canal or urethral opening. This can be treated surgically by repairing the opening of the urethra. It is commonly combined with a Caslick's operation.
Endometritis. This means uterine infection and can only be diagnosed with certainty by comparing the results of complete reproductive exam, culture and biopsy of the endometrium. In true uterine infections, the culture result indicates the presence of a true pathogenic (disease causing) organism (bacteria or fungus), and the interpretation of the biopsy shows the presence of inflammatory cells (white blood cells). Endometritis is treated with uterine lavages and antibiotics based on culture and sensitivity results.
Uterine cysts. These are dilated lymphatics relatively common in the uterus of older mares and they seldom affect fertility. When their effect on fertility is a concern and no other problems have been diagnosed, cysts may be removed manually or with the aid of a biopsy instrument. There are many fancy/expensive laser techniques described for removal of these cysts, but the effectiveness of these treatments and, especially, long term effects on fertility, have not been investigated.
Periglandular fibrosis / cystic glandular distension. These are degenerative changes of the uterine lining, most common in older mares or mares whose uteruses have been wrongly treated with caustic solutions such as povidone iodine or clorhexidine. These are irreversible changes and there is no appropriate treatment. Diagnosis is performed by interpretation of the uterine biopsy tissue sample.
The main problem associated with these changes is early embryonic loss, since the equine embryo depends on the secretions from the uterine glands until the placenta forms at 50 to 60 days of pregnancy. Please note that although these are chronic (long term), degenerative changes of the endometrium, the term endometriosis (exclusively a human problem) does NOT apply to horses. This term is mistakenly used in equine reproduction and often seen in horsemen and even veterinary oriented magazines, journals and textbooks.
Cervical tears. These tears are usually due to previous difficult foaling (dystocia). The cervix no longer acts as a barrier for the uterus. Most tears can be treated surgically, but require expertise and special instruments.
In summary, always request a complete reproductive history and BSE when purchasing a broodmare. If a mare has a history of infertility and no obvious problems are detected on a routine exam performed by your veterinarian always seek a second opinion. Chances are that your equine veterinarian and a reproduction expert (certified by the American College of Theriogenologists) can work together at diagnosing and managing your mare's reproductive problems.
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