Isolated and combined causes of equine dystocia

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For this reason, veterinary research is dependent on up-to-date data for optimising dystocia management. In addition, knowledge about the prognosis of dystocia cases is necessary for providing advice to animal owners. The present retrospective study of equine dystocia is intended to enrich the existing data set with up-to-date information. For the first time, the focus is on which causes of dystocia occur alone or in combination. Over a period of 10 years, 72 cases of dystocia were analysed using a standardised, predetermined diagnosis code. Results Of 72 cases of dystocia, an isolated cause of dystocia was identified in 31 cases (43%) and 41 animals showed a combination of two or more causes (57%). Foetal causes were significantly more common at 95.7% (95% confidence interval = [87.8%, 99.1%]) than maternal causes at 4.4% (95% confidence interval = [0.1%, 12.2%]) (p < 0.0001). Incorrect posture of the foetal forelimbs and head was the most common combination at 22% (9/41). The most common isolated cause of dystocia was found to be the incorrect posture of the foetal forelimbs (22.6% – 7/31). A fetotomy was performed in 68% of cases of dystocia (49/72). A caesarean section or an extraction was performed in 13.9% (10/72) of the cases. No obstetric procedures were performed in 3 of 72 cases of dystocia (4.2%). These mares died before obstetric care was provided. Nine mares (12.5% – 9/72) were not discharged alive after dystocia. 73 foals were born in 72 cases of dystocia (one twin pregnancy). 55 foals were already dead before veterinary treatment began. In relation to the total number of births in which the foetus was alive at the start of obstetric care, the foetal mortality rate was 61.1% (11/18) and 88.9% (16/18) by the time the mare was discharged. Conclusions It has been shown for the first time that combined causes of dystocia are more common in horses than isolated causes of dystocia. Neonatal mortality remains high, meaning that the timely detection and treatment of dystocia has the highest priority. dystocia causes foal mortality mare mortality Background Both mare and foal are at serious risk in the event of dystocia [ 1 , 2 ]. Rapid veterinary action is required to avoid serious health consequences for the mare and foal [ 3 ]. In the available literature, there is a number of case studies on causes of equine dystocia. However, there are no studies that differentiate between the occurrence of isolated and combined causes of dystocia. Using a standardised diagnostic code, this study from an obstetric clinic is intended to provide updated information on the diagnosed isolated and combined causes of dystocia and their consequences. Mortality rates and complications are analysed according to different obstetric procedures. These are intended to provide a contribution to the current state of knowledge on equine dystocia. Methods Animals Data was collected and analysed from mares that were presented to the Veterinary Clinic for Reproductive Medicine and Neonatology at the Justus Liebig University in the period 01.01.2010 to 31.12.2020 due to dystocia. To diagnose dystocia, a standardised obstetric examination procedure was carried out, which was defined before the start of this study. During the obstetric examination, the following vital parameters of the mare were first recorded by means of a general examination: - State of consciousness - Pulse and respiratory rates - Internal body temperature - Mucosal colour - Capillary refill time The specialist obstetric examination began with an adspection of the anogenital area. Attention was focused on oedema, injuries and discharge. During the subsequent manual vaginal examination, the condition of the soft birth canal was assessed. The following findings were recorded for the foetus: Presentation of the foetus: Anterior, posterior or transverse presentation Position of the foetus: dorsal, lateral or ventral position Posture of the foetus: extended posture or postural abnormalities of the head and/or limbs Location of the foetus: describes the condition of protruding, entering or exiting foetal parts in relation to the maternal pelvic cavity Size of the foetus: normal size, absolute (an above-average-sized foetus cannot pass through a fully dilated birth canal) or relative foetopelvic disproportion (an average-sized foetus cannot pass through a narrowed soft and/or bony birth canal) Whether the foetus is alive Only cases for which all the findings could be recorded were included in this analysis. Treatment was initiated based on the findings. Conservative obstetric procedures and fetotomies were performed on a standing, sedated mare under epidural anaesthesia. The caesarean section was performed under general anaesthesia in dorsal position in the linea alba. Statistical analysis To analyse the data, the statistical software SAS 9.4 (SAS® Institute Inc., 2013. Base SAS® 9.4 Procedures Guide: Statistical Procedures, 2nd edition ed. Statistical Analysis System Institute Inc., Cary, NC, USA) was used. A binomial test for uniform distribution was performed to analyse whether there was a significant difference in the frequency of foetal and maternal causes of dystocia. Animals with both maternal and foetal causes were excluded from the analysis. Results During the study period, 72 cases of dystocia were analysed. Treatment was carried out by fetotomy in 49 cases (49/72–68%). There were 26 total fetotomies (26/49–53%) and 23 partial fetotomies (23/49–47%). An extraction was performed ten times (10/72–13.9%) and caesarean section performed in ten other cases of dystocia (10/72–13.9%). No obstetric procedures were performed in three of 72 cases of dystocia (3/72–4.2%). In these cases, the mares died before obstetric care was provided. Causes of dystocia The 72 cases of dystocia were due to a total of 131 causes (Table 1 ). The total number of causes is larger than 72, as several pathological conditions sometimes occurred in an individual case of dystocia. An isolated cause of dystocia was identified in 31 mares (43% – 31/72) (Table 2 ), whereas 41 animals (57% – 41/72) displayed a combination of two or more causes (Table 3 ). Various manifestations of incorrect posture of the foetal forelimbs were most frequently involved in a case of dystocia, at 23.7% (31/131). The most common isolated cause of dystocia diagnosed was incorrect posture of the foetal forelimbs (22.6% – 7/31). At 16.1% (5/31) each, incorrect foetal presentation and absolute foetopelvic disproportion were the second most common isolated causes. Incorrect posture of the foetal forelimbs and head was the most common combination of causes at 22% (9/41). Table 1 Frequency of dystocia causes in the mare without subdivision into isolated and combined. Cause of dystocia Number of cases % Incorrect posture of the foetal forelimbs Bilateral carpal flexion 12 Unilateral carpal flexion 6 Unilateral shoulder flexion 6 Unilateral elbow flexion 4 Bilateral shoulder flexion 3 31 23.7 Incorrect posture of the foetal head Lateral deviation of the head 14 Ventral deviation of the head 8 Dorsal deviation of the head 1 23 17.6 Incorrect foetal presentation Posterior presentation 9 Ventrotransverse presentation 5 Abdominal vertical presentation 3 Dorsotransverse presentation 3 Transverse presentation 1 21 16 Incorrect posture of the foetal hindlimbs Bilateral hip flexion 9 Bilateral tarsal flexion 4 Unilateral hip flexion 2 Unilateral tarsal flexion 2 17 13 Incorrect foetal position Lateral position 7 Ventral position 5 12 9.2 Foetal malformations Malformation of the head 5 Hydrocephalus 4 Arthrogryposis of the hindlimbs 1 Ankylosis of the cervical spine 1 11 8.4 Foetopelvic disproportion Absolute foetopelvic disproportion 8 Relative foetopelvic disproportion 2 10 7.6 Uterine torsion intrapartum 3 2.3 Twins 2 1.5 Adhesions of uterus and peritoneum (on the abdominal suture of a previous operation) 1 0.8 Total 131 100 Table 2 Frequency of isolated causes of dystocia in the mare. Causes Number of cases % Incorrect posture of the foetal forelimb Bilateral carpal flexion 5 Unilateral elbow flexion 1 Bilateral shoulder flexion 1 7 22.6 Incorrect foetal presentation Ventrotransverse presentation 2 Dorsotransverse presentation 2 Abdominal vertical presentation 1 5 16.1 Foetopelvic disproportion Absolute foetopelvic disproportion 5 16.1 Incorrect posture of the foetal head Lateral deviation of the head 3 Dorsal deviation of the head 1 4 12.9 Incorrect foetal position Ventral position 2 Lateral position 1 3 9.7 Uterine torsion intrapartum 3 9.7 Foetal malformations Hydrocephalus 2 6.5 Incorrect posture of the foetal hindlimbs Bilateral tarsal flexion 1 3.2 Twins 1 3.2 Total 31 100 Table 3 Frequency of combined causes of dystocia in the mare. Combinations of causes Number of cases % Incorrect posture of FFL + incorrect posture of foetal head 9 22 Incorrect posture of FHL + incorrect foetal presentation 4 9.8 Incorrect posture of FFL + absolute foetopelvic disproportion 3 7.3 Incorrect posture of foetal head + relative foetopelvic disproportion 2 4.9 Incorrect posture of FFL + incorrect foetal presentation 2 4.9 Incorrect foetal presentation + foetal malformations 2 4.9 Incorrect foetal position + incorrect foetal presentation 2 4.9 Incorrect posture of FHL + incorrect posture of foetal head 1 2.4 Incorrect posture of FFL + incorrect posture of FHL + incorrect foetal position 1 2.4 Incorrect posture of FFL (carpal and shoulder) 1 2.4 Incorrect posture of FFL + incorrect foetal position 1 2.4 Incorrect posture of FFL + incorrect posture of foetal head + incorrect foetal position 1 2.4 Incorrect posture of FFL + incorrect posture of foetal head + incorrect foetal presentation 1 2.4 Incorrect posture of FFL + incorrect posture of foetal head + foetal malformations 1 2.4 Incorrect posture of FFL + incorrect posture of foetal head + incorrect posture of FHL + twins 1 2.4 Incorrect posture of FHL (tarsal and hip) 1 2.4 Incorrect posture of FHL + incorrect foetal presentation + foetal malformations 1 2.4 Incorrect posture of FHL + incorrect foetal position + incorrect foetal presentation 1 2.4 Incorrect posture of FHL + incorrect foetal position + incorrect foetal presentation + foetal malformations 1 2.4 Incorrect posture of foetal head + incorrect foetal position 1 2.4 Incorrect posture of foetal head + incorrect posture of FHL + incorrect foetal presentation 1 2.4 Incorrect posture of foetal head + incorrect foetal position + foetal malformations 1 2.4 Incorrect posture of FHL + foetal malformations 1 2.4 Incorrect foetal presentation + incorrect posture of FHL + adhesions of the uterus and peritoneum (at abdominal suture) 1 2.4 Total 41 100 FFL: Foetal forelimbs FHL: Foetal hindlimbs 95.4% (125/131) of the causes of dystocia were linked to the foetus. Maternal causes of dystocia amounted to 4.6% (6/131) of cases and were caused three times by a torsio uteri intra partum, twice by relative foetopelvic disproportion and once by a postoperative adhesion of the uterus and peritoneum. Overall, a foetal cause was found significantly more frequently at 95.7% (95% confidence interval = [87.8%, 99.1%]) than maternal causes at 4.4% (95% confidence interval = [0.1%, 12.2%]) (p < 0.0001). Mare mortality A total of nine mares (12.5% – 9/72) were not discharged alive after dystocia (Table 4 ). Three of these nine mares died before obstetric care was provided. Of these patients, two were euthanised at the owners’ request due to poor prognosis and the other animal died during the examination. A fourth mare did not survive the caesarean section. Table 4 Maternal mortality rate in relation to the obstetric procedures Type of obstetric care Died Discharged alive before obstetric care during obstetric care before being discharged Partial fetotomy 3 20 Total fetotomy 1 25 Conservative obstetric care 1 9 Caesarean section 1 9 No obstetric care Euthanasia at owner’s request 2 Died during initial examination 1 Total 3 1 5 63 9/72 12.5% The five remaining mares survived the obstetric procedures but died before they were discharged. Of these five animals, one mare was euthanised the day after conservative obstetrics. The other four mares were euthanised in the days following a fetotomy. In three of these mares, uterine perforation was diagnosed after or during a partial fetotomy. A mesenteric rupture was suspected after a total fetotomy in the fourth mare. In relation to the obstetric procedures, the maternal mortality rate for a fetotomy was 8.2% (4/49), with 13% (3/23) as part of a partial fetotomy and 3.8% (1/26) after a total fetotomy. 10% (1/10) of the mares died after both conservative obstetric care and a caesarean section. Foal mortality Due to a twin pregnancy, 73 foetuses were born from 72 pregnancies. At presentation, the foetus was still alive in 18 cases and 55 foals were already dead before the start of veterinary treatment (Table 5 ). Seven foals were born alive. Two of these foals died within the first 24 hours after birth. Three foals were euthanised before the mother was discharged, due to deformities. Two foals were discharged alive. In relation to the total number of births in which the foetus was alive at the start of obstetric care, the foetal mortality rate was 61.1% (11/18) and 88.9% (16/18) by the time the mother was discharged. Categorised according to the respective obstetric procedure performed, the foetal mortality rate for conservative obstetric care was 60% (6/10) and 80% (8/10) before the mare was discharged. Five out of eight foetuses were not delivered alive during caesarean section. None of the foals that were alive at the start of the caesarean section could be discharged alive (100% – 8/8). Table 5 Foetal mortality in relation to the obstetric procedures Type of obstetric care Died before obstetric care Died Discharged alive during obstetric care before being discharged Partial fetotomy 24 Total fetotomy 26 No obstetric care 3 Conservative obstetric care 6 2 2 Caesarean section 2 5 3 Total 55 11 5 2 16/18 88.9% Discussion In the literature, there is a number of publications that deal with the causes of dystocia in horses. But they do not consider that different causes of dystocia can occur in combination, although this aspect is important to know in terms of treatment. At 57%, combined disorders occurred more frequently than isolated causes. Foetal causes of dystocia occurred significantly more frequently than maternal causes in the present study. The literature suggests that the most common cause of dystocia is generally incorrect posture of the foetus, caused in particular by the foal’s long extremities [ 4 , 5 ]. In the present study, postural deviations of the forelimbs were the most common general (23.7%) and isolated (22.6%) cause of dystocia. This result is not consistent with the findings of other publications [ 6 – 8 ], who reported an isolated incorrect foetal posture of the head and neck as the most common cause of dystocia in a specialist obstetric clinic. It should be noted that in the present study a foetal deviation of head/neck posture was the second most common cause of dystocia. As an isolated cause of dystocia, it was determined to be the fourth most common cause after incorrect positioning and absolute foetopelvic disproportion. The large number of postural abnormalities shows how important it is that veterinarians who care for broodmares are trained in correcting these abnormalities. It is notable that the literature seldom discusses combinations of causes for incorrect posture of the extremities. Two studies point out that the incorrect posture of head and forelimb also occurred in combination in their studies, but without stating exact data [ 1 , 9 ]. Only Frazer et al. [ 10 ] state in their survey of two obstetric clinics that the combination of causes of dystocia of incorrect posture of the foetal head and forelimbs was diagnosed in 10% (15/150) of dystocia cases. In another study [ 11 ], a lower value of 3.8% (4/106) was given for the occurrence of incorrect posture of the head and limbs as the only combination of causes. However, the aforementioned study was not carried out at an obstetric clinic with dystocia as the reason for presentation, but in a facility for birth monitoring, and therefore is only comparable to a limited extent. Vandeplassche [ 12 ] takes the view that dystocia cases in an obstetric clinic are primarily “complicated” cases and should be distinguished from dystocia in a veterinary practice. This fact has been reflected in our own study, in that a large number of foetuses were already dead on presentation at the clinic and there was a high mortality rate even after a live foal was born. The most common combination in the present study was the diagnosis of incorrect posture of the foetal head and forelimbs as a combination of causes. The second most common cause, the combination of an incorrect posture of the foetal hindlimbs with an incorrect position, occurred much less frequently, at 9.8%. In relation to all 72 cases of dystocia, incorrect posture of the head and forelimbs was diagnosed in 12.5% of cases. This confirms the results of the only comparable study with a slight deviation of 2.5% [ 10 ]. Foetal causes of dystocia occurred significantly more frequently than maternal causes in the present study. This confirms the prevalent findings of retrospective studies that equine dystocia is primarily of foetal origin [ 8 , 13 , 14 ]. A recent prospective study on dystocia in horses also found that the causes of dystocia were more often foetal than maternal [ 15 ]. In the present study, nine of the seventy-two mares were not discharged alive after dystocia. Differentiated according to the respective obstetric procedure, the mortality rate after a partial fetotomy was 13% and 3.8% after a total fetotomy. This result is significant in that a literature research showed a lower mortality rate in the period 1991–2021 for partial fetotomy of 9%, compared to total fetotomy (27%) [ 13 ]. For this reason, the literature has so far attributed a higher risk of death for the mare after a total fetotomy [ 16 ]. In this context, however, it should be mentioned that some studies made no distinction between partial and total fetotomies and, at the same time, showed similar average mortality rates as in the present study of 8.2% [ 12 , 17 ]. The prevailing opinion, that total fetotomies inherently represent a greater risk of mortality to the mare than partial fetotomies, should therefore be examined in future studies. A literature review of case studies for equine caesarean sections published between 1991–2021 showed an average maternal mortality of 14%, which is of the same order of magnitude as the data presented [ 13 ]. There is also only a slight deviation with regard to maternal mortality from one of the few publications in which conservative obstetrics were performed without general anaesthesia and which mentions a mare mortality rate of 13.6% [ 6 ]. The present study has found a similar mare mortality rate of 10% (1/10). With dystocia, the risk of a stillborn foal is ten times higher than with eutocia [ 18 ]. A comparable survey shows that following conservative or operative obstetric care, there is a foetal mortality rate of 95% up to discharge [ 6 ]. This figure is consistent with the foetal mortality rate in the present study, which at 88.9% (16/18) also points to a high foetal mortality rate before discharge. In the case of caesarean sections, very high foetal mortality rates were also reported in the literature. Based on 6 studies, an average foetal death rate of 75% (163/216) up until the time of discharge was determined for the period 1991–2021 [ 13 ]. The individual mortality rates vary from 69–96% and are therefore close to the maximum foetal mortality rate of 100% (8/8) in the present study. Comparable foetal mortality rates with respect to conservative obstetric care without general anaesthesia are not available. The value determined here of 80% (8/10) at the time of discharge should be categorised as high. Conclusions In summary, foetal and maternal mortality in the mare remains very high in comparison to older publications, when data is collected in an obstetric clinic in which cases are characterised by complications and treatment is delayed due to transport from the stable to the clinic. This underlines the importance of early detection of a dystocia and of the provision of treatment with as little delay as possible. Declarations Authors’ contributions AW and JK proposed and designed the experiment. KB supported the statistical data evaluation. ME collected and analysed the data. AW and ME drafted and edited the manuscript. All authors have read and approved the final version of the manuscript. Acknowledgements Not applicable. Competing interests The authors declare that they have no competing interests. Availability of data and materials The data supporting this study's findings can be made available from the corresponding author upon reasonable request. Consent for publication Written consent from animal owners was obtained upon the mares' admission to the clinic, permitting the use of their data. Ethics approval The data was gathered during veterinary procedures and is subject to approval by the Giessen Regional Council (kTV8-2017) for use. Prior publication The data present herein have not been previously published. Funding No funding. References Leidl W, Stolla R, Schmid G. Zur Schwergeburt bei der Stute. I. Ursachen, konservative Geburtshilfe und Fetotomie. Tierärztl Umsch. 1993;48:408–12. Ellerbrock M, Wehrend A. Definition, incidence and causes of dystocia in horses – a review of the literature. 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J Am Vet Med Assoc. 2007;230:1502–5. doi:10.2460/javma.230.10.1502. Karadjole T, Bačić G, Mačešić N, Karadjole M, Dobranić T, Makek Z, et al. Ursachen von Dystokien bei Stuten. Tierärztl Umsch. 2008;63:183–5. Vandeplassche M. The pathogenesis of dystocia and fetal malformation in the horse. J Reprod Fertil Suppl. 1987;35:547–52. Frazer GS, Perkins NR, Blanchard TL, Orsini J, Threlfall WR. Prevalence of fetal maldispositions in equine referral hospital dystocias. Equine Vet J. 1997;29:111–6. doi:10.1111/j.2042-3306.1997.tb01651.x. McCue PM, Ferris RA. Parturition, dystocia and foal survival: A retrospective study of 1047 births. Equine Vet J Suppl. 2012:22–5. doi:10.1111/j.2042-3306.2011.00476.x. Vandeplassche M. Selected Topics in Equine Obstetrics. Proc Am Ass Equine Practnrs. 1992;38:623–8. Ellerbrock M, Wehrend A. Morbidity and mortality of mare and foal following dystocia – a literature review. Tierarztl Prax Ausg G Grosstiere Nutztiere. 2023;51:314–26. doi:10.1055/a-2180-2182. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4007597","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":286986357,"identity":"b85fb5e7-5265-4ff9-a256-bc04423f0f47","order_by":0,"name":"Markus Ellerbrock","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0000-3695-3522","institution":"Justus Liebig University Giessen: Justus-Liebig-Universitat Giessen","correspondingAuthor":true,"prefix":"","firstName":"Markus","middleName":"","lastName":"Ellerbrock","suffix":""},{"id":286986358,"identity":"3fd9c285-004c-45cb-967a-41ab2909d760","order_by":1,"name":"Judith Krohn","email":"","orcid":"","institution":"University of Giessen: Justus-Liebig-Universitat Giessen","correspondingAuthor":false,"prefix":"","firstName":"Judith","middleName":"","lastName":"Krohn","suffix":""},{"id":286986359,"identity":"4ddce3d1-90b7-4530-a4c8-272e54556cee","order_by":2,"name":"Kathrin Büttner","email":"","orcid":"","institution":"University of Giessen: Justus-Liebig-Universitat Giessen","correspondingAuthor":false,"prefix":"","firstName":"Kathrin","middleName":"","lastName":"Büttner","suffix":""},{"id":286986360,"identity":"cd06df30-95fe-4ea6-9739-956d949175a1","order_by":3,"name":"Axel Wehrend","email":"","orcid":"","institution":"University of Giessen: Justus-Liebig-Universitat Giessen","correspondingAuthor":false,"prefix":"","firstName":"Axel","middleName":"","lastName":"Wehrend","suffix":""}],"badges":[],"createdAt":"2024-03-03 05:31:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4007597/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4007597/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13028-024-00772-8","type":"published","date":"2024-10-11T15:57:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66597203,"identity":"146c61e1-cd46-4755-9d61-57785a687540","added_by":"auto","created_at":"2024-10-14 16:08:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":616055,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4007597/v1/a54cfa5d-d7ff-4d01-a5df-f0b03b468197.pdf"}],"financialInterests":"","formattedTitle":"Isolated and combined causes of equine dystocia","fulltext":[{"header":"Background","content":"\u003cp\u003eBoth mare and foal are at serious risk in the event of dystocia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Rapid veterinary action is required to avoid serious health consequences for the mare and foal [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the available literature, there is a number of case studies on causes of equine dystocia. However, there are no studies that differentiate between the occurrence of isolated and combined causes of dystocia.\u003c/p\u003e \u003cp\u003eUsing a standardised diagnostic code, this study from an obstetric clinic is intended to provide updated information on the diagnosed isolated and combined causes of dystocia and their consequences. Mortality rates and complications are analysed according to different obstetric procedures. These are intended to provide a contribution to the current state of knowledge on equine dystocia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAnimals\u003c/h2\u003e \u003cp\u003eData was collected and analysed from mares that were presented to the Veterinary Clinic for Reproductive Medicine and Neonatology at the Justus Liebig University in the period 01.01.2010 to 31.12.2020 due to dystocia.\u003c/p\u003e \u003cp\u003eTo diagnose dystocia, a standardised obstetric examination procedure was carried out, which was defined before the start of this study.\u003c/p\u003e \u003cp\u003eDuring the obstetric examination, the following vital parameters of the mare were first recorded by means of a general examination:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- State of consciousness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Pulse and respiratory rates\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Internal body temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Mucosal colour\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Capillary refill time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe specialist obstetric examination began with an adspection of the anogenital area. Attention was focused on oedema, injuries and discharge. During the subsequent manual vaginal examination, the condition of the soft birth canal was assessed. The following findings were recorded for the foetus:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePresentation of the foetus: Anterior, posterior or transverse presentation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePosition of the foetus: dorsal, lateral or ventral position\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePosture of the foetus: extended posture or postural abnormalities of the head and/or limbs\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLocation of the foetus: describes the condition of protruding, entering or exiting foetal parts in relation to the maternal pelvic cavity\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSize of the foetus: normal size, absolute (an above-average-sized foetus cannot pass through a fully dilated birth canal) or relative foetopelvic disproportion (an average-sized foetus cannot pass through a narrowed soft and/or bony birth canal)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhether the foetus is alive\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eOnly cases for which all the findings could be recorded were included in this analysis.\u003c/p\u003e \u003cp\u003eTreatment was initiated based on the findings. Conservative obstetric procedures and fetotomies were performed on a standing, sedated mare under epidural anaesthesia. The caesarean section was performed under general anaesthesia in dorsal position in the linea alba.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eTo analyse the data, the statistical software SAS 9.4 (SAS\u0026reg; Institute Inc., 2013. Base SAS\u0026reg; 9.4 Procedures Guide: Statistical Procedures, 2nd edition ed. Statistical Analysis System Institute Inc., Cary, NC, USA) was used.\u003c/p\u003e \u003cp\u003eA binomial test for uniform distribution was performed to analyse whether there was a significant difference in the frequency of foetal and maternal causes of dystocia. Animals with both maternal and foetal causes were excluded from the analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, 72 cases of dystocia were analysed. Treatment was carried out by fetotomy in 49 cases (49/72\u0026ndash;68%). There were 26 total fetotomies (26/49\u0026ndash;53%) and 23 partial fetotomies (23/49\u0026ndash;47%). An extraction was performed ten times (10/72\u0026ndash;13.9%) and caesarean section performed in ten other cases of dystocia (10/72\u0026ndash;13.9%). No obstetric procedures were performed in three of 72 cases of dystocia (3/72\u0026ndash;4.2%). In these cases, the mares died before obstetric care was provided.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCauses of dystocia\u003c/h2\u003e \u003cp\u003eThe 72 cases of dystocia were due to a total of 131 causes (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The total number of causes is larger than 72, as several pathological conditions sometimes occurred in an individual case of dystocia. An isolated cause of dystocia was identified in 31 mares (43% \u0026ndash; 31/72) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), whereas 41 animals (57% \u0026ndash; 41/72) displayed a combination of two or more causes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Various manifestations of incorrect posture of the foetal forelimbs were most frequently involved in a case of dystocia, at 23.7% (31/131). The most common isolated cause of dystocia diagnosed was incorrect posture of the foetal forelimbs (22.6% \u0026ndash; 7/31). At 16.1% (5/31) each, incorrect foetal presentation and absolute foetopelvic disproportion were the second most common isolated causes. Incorrect posture of the foetal forelimbs and head was the most common combination of causes at 22% (9/41).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of dystocia causes in the mare without subdivision into isolated and combined.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eCause of dystocia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eIncorrect posture of the foetal forelimbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBilateral carpal flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnilateral carpal flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnilateral shoulder flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnilateral elbow flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBilateral shoulder flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eIncorrect posture of the foetal head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLateral deviation of the head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eVentral deviation of the head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDorsal deviation of the head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"5\" nameend=\"c2\" namest=\"c1\" rowspan=\"6\"\u003e \u003cp\u003eIncorrect foetal presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePosterior presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVentrotransverse presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbdominal vertical presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDorsotransverse presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTransverse presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c2\" namest=\"c1\" rowspan=\"5\"\u003e \u003cp\u003eIncorrect posture of the foetal hindlimbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBilateral hip flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBilateral tarsal flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnilateral hip flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnilateral tarsal flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eIncorrect foetal position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLateral position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVentral position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c2\" namest=\"c1\" rowspan=\"5\"\u003e \u003cp\u003eFoetal malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMalformation of the head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHydrocephalus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArthrogryposis of the hindlimbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnkylosis of the cervical spine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eFoetopelvic disproportion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbsolute foetopelvic disproportion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRelative foetopelvic disproportion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eUterine torsion intrapartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTwins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAdhesions of uterus and peritoneum (on the abdominal suture of a previous operation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of isolated causes of dystocia in the mare.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCauses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eIncorrect posture of the foetal forelimb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilateral carpal flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnilateral elbow flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilateral shoulder flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eIncorrect foetal presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVentrotransverse presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDorsotransverse presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal vertical presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoetopelvic disproportion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsolute foetopelvic disproportion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIncorrect posture of the foetal head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLateral deviation of the head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDorsal deviation of the head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIncorrect foetal position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVentral position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLateral position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eUterine torsion intrapartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoetal malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHydrocephalus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of the foetal hindlimbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilateral tarsal flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTwins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of combined causes of dystocia in the mare.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombinations of causes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FFL\u0026thinsp;+\u0026thinsp;incorrect posture of foetal head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FHL\u0026thinsp;+\u0026thinsp;incorrect foetal presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FFL\u0026thinsp;+\u0026thinsp;absolute foetopelvic disproportion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of foetal head\u0026thinsp;+\u0026thinsp;relative foetopelvic disproportion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FFL\u0026thinsp;+\u0026thinsp;incorrect foetal presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect foetal presentation\u0026thinsp;+\u0026thinsp;foetal malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect foetal position\u0026thinsp;+\u0026thinsp;incorrect foetal presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FHL\u0026thinsp;+\u0026thinsp;incorrect posture of foetal head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FFL\u0026thinsp;+\u0026thinsp;incorrect posture of FHL\u0026thinsp;+\u0026thinsp;incorrect foetal position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FFL (carpal and shoulder)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FFL\u0026thinsp;+\u0026thinsp;incorrect foetal position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FFL\u0026thinsp;+\u0026thinsp;incorrect posture of foetal head\u0026thinsp;+\u0026thinsp;incorrect foetal position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FFL\u0026thinsp;+\u0026thinsp;incorrect posture of foetal head\u0026thinsp;+\u0026thinsp;incorrect foetal presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FFL\u0026thinsp;+\u0026thinsp;incorrect posture of foetal head\u0026thinsp;+\u0026thinsp;foetal malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FFL\u0026thinsp;+\u0026thinsp;incorrect posture of foetal head\u0026thinsp;+\u0026thinsp;incorrect posture of FHL\u0026thinsp;+\u0026thinsp;twins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FHL (tarsal and hip)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FHL\u0026thinsp;+\u0026thinsp;incorrect foetal presentation\u0026thinsp;+\u0026thinsp;foetal malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FHL\u0026thinsp;+\u0026thinsp;incorrect foetal position\u0026thinsp;+\u0026thinsp;incorrect foetal presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FHL\u0026thinsp;+\u0026thinsp;incorrect foetal position\u0026thinsp;+\u0026thinsp;incorrect foetal presentation\u0026thinsp;+\u0026thinsp;foetal malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of foetal head\u0026thinsp;+\u0026thinsp;incorrect foetal position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of foetal head\u0026thinsp;+\u0026thinsp;incorrect posture of FHL\u0026thinsp;+\u0026thinsp;incorrect foetal presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of foetal head\u0026thinsp;+\u0026thinsp;incorrect foetal position\u0026thinsp;+\u0026thinsp;foetal malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect posture of FHL\u0026thinsp;+\u0026thinsp;foetal malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncorrect foetal presentation\u0026thinsp;+\u0026thinsp;incorrect posture of FHL\u0026thinsp;+\u0026thinsp;adhesions of the uterus and peritoneum (at abdominal suture)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eFFL: Foetal forelimbs\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eFHL: Foetal hindlimbs\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e95.4% (125/131) of the causes of dystocia were linked to the foetus. Maternal causes of dystocia amounted to 4.6% (6/131) of cases and were caused three times by a torsio uteri intra partum, twice by relative foetopelvic disproportion and once by a postoperative adhesion of the uterus and peritoneum. Overall, a foetal cause was found significantly more frequently at 95.7% (95% confidence interval = [87.8%, 99.1%]) than maternal causes at 4.4% (95% confidence interval = [0.1%, 12.2%]) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMare mortality\u003c/h2\u003e \u003cp\u003eA total of nine mares (12.5% \u0026ndash; 9/72) were not discharged alive after dystocia (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Three of these nine mares died before obstetric care was provided. Of these patients, two were euthanised at the owners\u0026rsquo; request due to poor prognosis and the other animal died during the examination. A fourth mare did not survive the caesarean section.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal mortality rate in relation to the obstetric procedures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eType of\u003c/p\u003e \u003cp\u003eobstetric care\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDischarged alive\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ebefore obstetric care\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eduring\u003c/p\u003e \u003cp\u003eobstetric care\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ebefore being discharged\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePartial fetotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal fetotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eConservative obstetric care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCaesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eobstetric care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEuthanasia at owner\u0026rsquo;s request\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDied during initial examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003e9/72\u003c/p\u003e \u003cp\u003e12.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe five remaining mares survived the obstetric procedures but died before they were discharged. Of these five animals, one mare was euthanised the day after conservative obstetrics. The other four mares were euthanised in the days following a fetotomy. In three of these mares, uterine perforation was diagnosed after or during a partial fetotomy. A mesenteric rupture was suspected after a total fetotomy in the fourth mare. In relation to the obstetric procedures, the maternal mortality rate for a fetotomy was 8.2% (4/49), with 13% (3/23) as part of a partial fetotomy and 3.8% (1/26) after a total fetotomy. 10% (1/10) of the mares died after both conservative obstetric care and a caesarean section.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFoal mortality\u003c/h2\u003e \u003cp\u003eDue to a twin pregnancy, 73 foetuses were born from 72 pregnancies. At presentation, the foetus was still alive in 18 cases and 55 foals were already dead before the start of veterinary treatment (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Seven foals were born alive. Two of these foals died within the first 24 hours after birth. Three foals were euthanised before the mother was discharged, due to deformities. Two foals were discharged alive. In relation to the total number of births in which the foetus was alive at the start of obstetric care, the foetal mortality rate was 61.1% (11/18) and 88.9% (16/18) by the time the mother was discharged. Categorised according to the respective obstetric procedure performed, the foetal mortality rate for conservative obstetric care was 60% (6/10) and 80% (8/10) before the mare was discharged. Five out of eight foetuses were not delivered alive during caesarean section. None of the foals that were alive at the start of the caesarean section could be discharged alive (100% \u0026ndash; 8/8).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFoetal mortality in relation to the obstetric procedures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of\u003c/p\u003e \u003cp\u003eobstetric care\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003cp\u003ebefore obstetric care\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDischarged alive\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eduring\u003c/p\u003e \u003cp\u003eobstetric care\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ebefore being discharged\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial fetotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal fetotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eobstetric care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConservative obstetric care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e16/18\u003c/p\u003e \u003cp\u003e88.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the literature, there is a number of publications that deal with the causes of dystocia in horses. But they do not consider that different causes of dystocia can occur in combination, although this aspect is important to know in terms of treatment. At 57%, combined disorders occurred more frequently than isolated causes. Foetal causes of dystocia occurred significantly more frequently than maternal causes in the present study.\u003c/p\u003e \u003cp\u003eThe literature suggests that the most common cause of dystocia is generally incorrect posture of the foetus, caused in particular by the foal\u0026rsquo;s long extremities [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the present study, postural deviations of the forelimbs were the most common general (23.7%) and isolated (22.6%) cause of dystocia. This result is not consistent with the findings of other publications [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], who reported an isolated incorrect foetal posture of the head and neck as the most common cause of dystocia in a specialist obstetric clinic. It should be noted that in the present study a foetal deviation of head/neck posture was the second most common cause of dystocia. As an isolated cause of dystocia, it was determined to be the fourth most common cause after incorrect positioning and absolute foetopelvic disproportion. The large number of postural abnormalities shows how important it is that veterinarians who care for broodmares are trained in correcting these abnormalities. It is notable that the literature seldom discusses combinations of causes for incorrect posture of the extremities. Two studies point out that the incorrect posture of head and forelimb also occurred in combination in their studies, but without stating exact data [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Only Frazer et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] state in their survey of two obstetric clinics that the combination of causes of dystocia of incorrect posture of the foetal head and forelimbs was diagnosed in 10% (15/150) of dystocia cases. In another study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], a lower value of 3.8% (4/106) was given for the occurrence of incorrect posture of the head and limbs as the only combination of causes. However, the aforementioned study was not carried out at an obstetric clinic with dystocia as the reason for presentation, but in a facility for birth monitoring, and therefore is only comparable to a limited extent. Vandeplassche [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] takes the view that dystocia cases in an obstetric clinic are primarily \u0026ldquo;complicated\u0026rdquo; cases and should be distinguished from dystocia in a veterinary practice. This fact has been reflected in our own study, in that a large number of foetuses were already dead on presentation at the clinic and there was a high mortality rate even after a live foal was born. The most common combination in the present study was the diagnosis of incorrect posture of the foetal head and forelimbs as a combination of causes. The second most common cause, the combination of an incorrect posture of the foetal hindlimbs with an incorrect position, occurred much less frequently, at 9.8%. In relation to all 72 cases of dystocia, incorrect posture of the head and forelimbs was diagnosed in 12.5% of cases. This confirms the results of the only comparable study with a slight deviation of 2.5% [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Foetal causes of dystocia occurred significantly more frequently than maternal causes in the present study. This confirms the prevalent findings of retrospective studies that equine dystocia is primarily of foetal origin [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A recent prospective study on dystocia in horses also found that the causes of dystocia were more often foetal than maternal [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, nine of the seventy-two mares were not discharged alive after dystocia. Differentiated according to the respective obstetric procedure, the mortality rate after a partial fetotomy was 13% and 3.8% after a total fetotomy. This result is significant in that a literature research showed a lower mortality rate in the period 1991\u0026ndash;2021 for partial fetotomy of 9%, compared to total fetotomy (27%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For this reason, the literature has so far attributed a higher risk of death for the mare after a total fetotomy [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In this context, however, it should be mentioned that some studies made no distinction between partial and total fetotomies and, at the same time, showed similar average mortality rates as in the present study of 8.2% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The prevailing opinion, that total fetotomies inherently represent a greater risk of mortality to the mare than partial fetotomies, should therefore be examined in future studies. A literature review of case studies for equine caesarean sections published between 1991\u0026ndash;2021 showed an average maternal mortality of 14%, which is of the same order of magnitude as the data presented [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. There is also only a slight deviation with regard to maternal mortality from one of the few publications in which conservative obstetrics were performed without general anaesthesia and which mentions a mare mortality rate of 13.6% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The present study has found a similar mare mortality rate of 10% (1/10).\u003c/p\u003e \u003cp\u003eWith dystocia, the risk of a stillborn foal is ten times higher than with eutocia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A comparable survey shows that following conservative or operative obstetric care, there is a foetal mortality rate of 95% up to discharge [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This figure is consistent with the foetal mortality rate in the present study, which at 88.9% (16/18) also points to a high foetal mortality rate before discharge. In the case of caesarean sections, very high foetal mortality rates were also reported in the literature. Based on 6 studies, an average foetal death rate of 75% (163/216) up until the time of discharge was determined for the period 1991\u0026ndash;2021 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The individual mortality rates vary from 69\u0026ndash;96% and are therefore close to the maximum foetal mortality rate of 100% (8/8) in the present study. Comparable foetal mortality rates with respect to conservative obstetric care without general anaesthesia are not available. The value determined here of 80% (8/10) at the time of discharge should be categorised as high.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, foetal and maternal mortality in the mare remains very high in comparison to older publications, when data is collected in an obstetric clinic in which cases are characterised by complications and treatment is delayed due to transport from the stable to the clinic. This underlines the importance of early detection of a dystocia and of the provision of treatment with as little delay as possible.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eAW and JK proposed and designed the experiment. KB supported the statistical data evaluation. ME collected and analysed the data. AW and ME drafted and edited the manuscript. All authors have read and approved the final version of the manuscript. \u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eAcknowledgements\u0026nbsp;\u003c/h3\u003e\n\u003ch3\u003eNot applicable.\u003c/h3\u003e\n\u003ch3\u003eCompeting interests\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch3\u003eAvailability of data and materials\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe data supporting this study\u0026apos;s findings can be made available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eWritten consent from animal owners was obtained upon the mares\u0026apos; admission to the clinic, permitting the use of their data.\u003c/p\u003e\n\u003ch3\u003eEthics approval\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe data was gathered during veterinary procedures and is subject to approval by the Giessen Regional Council (kTV8-2017) for use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrior publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data present herein have not been previously published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo funding.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLeidl W, Stolla R, Schmid G. Zur Schwergeburt bei der Stute. I. Ursachen, konservative Geburtshilfe und Fetotomie. Tier\u0026auml;rztl Umsch. 1993;48:408\u0026ndash;12.\u003c/li\u003e\n \u003cli\u003eEllerbrock M, Wehrend A. Definition, incidence and causes of dystocia in horses \u0026ndash; a review of the literature. Tier\u0026auml;rztl Prax Ausg G Grosstiere Nutztiere. 2023;51:22\u0026ndash;34. doi:10.1055/a-2006-9248.\u003c/li\u003e\n \u003cli\u003eKaradjole T, Bačić G, Makek Z, Tomasković A, Cergolj M, Dobranić T, et al. Einfluss der Fetotomie auf die Stutenfruchtbarkeit. Tier\u0026auml;rztl Umsch. 2007;62:595\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eBlanchard TL, Morehead JP, Whitman JL, Peterson E. S. How to Provide Obstetrical Intervention in Equine Ambulatory Practice. Proc Am Ass Equine Practnrs. 2011;57:280\u0026ndash;3.\u003c/li\u003e\n \u003cli\u003eMc Gladdery A. Dystocia and postpartum complications in the mare. In Practice. 2001;23:74\u0026ndash;80. doi:10.1136/inpract.23.2.74.\u003c/li\u003e\n \u003cli\u003eFreeman DE, Hungerford LL, Schaeffer D, Lock TF, Sertich PL, Baker GJ, et al. Caesarean section and other methods for assisted delivery: Comparison of effects on mare mortality and complications. Equine Vet J. 1999;31:203\u0026ndash;7. doi:10.1111/j.2042-3306.1999.tb03173.x.\u003c/li\u003e\n \u003cli\u003eCarluccio A, Contri A, Tosi U, Amicis I de, Fanti C de. Survival rate and short-term fertility rate associated with the use of fetotomy for resolution of dystocia in mares: 72 cases (1991-2005). J Am Vet Med Assoc. 2007;230:1502\u0026ndash;5. doi:10.2460/javma.230.10.1502.\u003c/li\u003e\n \u003cli\u003eKaradjole T, Bačić G, Mače\u0026scaron;ić N, Karadjole M, Dobranić T, Makek Z, et al. Ursachen von Dystokien bei Stuten. Tier\u0026auml;rztl Umsch. 2008;63:183\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eVandeplassche M. The pathogenesis of dystocia and fetal malformation in the horse. J Reprod Fertil Suppl. 1987;35:547\u0026ndash;52.\u003c/li\u003e\n \u003cli\u003eFrazer GS, Perkins NR, Blanchard TL, Orsini J, Threlfall WR. Prevalence of fetal maldispositions in equine referral hospital dystocias. Equine Vet J. 1997;29:111\u0026ndash;6. doi:10.1111/j.2042-3306.1997.tb01651.x.\u003c/li\u003e\n \u003cli\u003eMcCue PM, Ferris RA. Parturition, dystocia and foal survival: A retrospective study of 1047 births. Equine Vet J Suppl. 2012:22\u0026ndash;5. doi:10.1111/j.2042-3306.2011.00476.x.\u003c/li\u003e\n \u003cli\u003eVandeplassche M. Selected Topics in Equine Obstetrics. Proc Am Ass Equine Practnrs. 1992;38:623\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eEllerbrock M, Wehrend A. Morbidity and mortality of mare and foal following dystocia \u0026ndash; a literature review. Tierarztl Prax Ausg G Grosstiere Nutztiere. 2023;51:314\u0026ndash;26. doi:10.1055/a-2180-2182.\u003c/li\u003e\n \u003cli\u003eLanci A, Perina F, Donadoni A, Castagnetti C, Mariella J. Dystocia in the Standardbred Mare: A Retrospective Study from 2004 to 2020. Animals (Basel) 2022. doi:10.3390/ani12121486.\u003c/li\u003e\n \u003cli\u003eEllerbrock M, Krohn J, B\u0026uuml;ttner K, Wehrend A. Dystocia frequency and causes in horses with pregnancy disorders or a history of dystocia: A prospective study. Reprod Domest Anim. 2024;59:e14541. doi:10.1111/rda.14541.\u003c/li\u003e\n \u003cli\u003eStolla R, Leidl W, Schmid G. Zur Schwergeburt bei der Stute: II. Sectio Caesarea. Tier\u0026auml;rztl Umsch. 1997;52:85\u0026ndash;91.\u003c/li\u003e\n \u003cli\u003eWehrend A, Herfen K, Hospes R, Bostedt H. Die Fetotomie als geburtshilfliche Operation beim Pferd unter besonderer Ber\u0026uuml;cksichtigung der puerperalen Behandlung - eine Follow-up Studie. DVG- Tagung der Fachgruppe \u0026quot;Pferdekrankheiten\u0026quot;, Wiesbaden, 16-17 M\u0026auml;rz 2000; 278-81. \u003c/li\u003e\n \u003cli\u003eMorley PS, Townsend HG. A survey of reproductive performance in Thoroughbred mares and morbidity, mortality and athletic potential of their foals. Equine Vet J. 1997;29:290\u0026ndash;7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"dystocia causes, foal mortality, mare mortality","lastPublishedDoi":"10.21203/rs.3.rs-4007597/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4007597/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDystocia is not common in horses, but is life-threatening for both mare and foal. For this reason, veterinary research is dependent on up-to-date data for optimising dystocia management. In addition, knowledge about the prognosis of dystocia cases is necessary for providing advice to animal owners. The present retrospective study of equine dystocia is intended to enrich the existing data set with up-to-date information. For the first time, the focus is on which causes of dystocia occur alone or in combination. Over a period of 10 years, 72 cases of dystocia were analysed using a standardised, predetermined diagnosis code.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 72 cases of dystocia, an isolated cause of dystocia was identified in 31 cases (43%) and 41 animals showed a combination of two or more causes (57%). Foetal causes were significantly more common at 95.7% (95% confidence interval = [87.8%, 99.1%]) than maternal causes at 4.4% (95% confidence interval = [0.1%, 12.2%]) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Incorrect posture of the foetal forelimbs and head was the most common combination at 22% (9/41). The most common isolated cause of dystocia was found to be the incorrect posture of the foetal forelimbs (22.6% \u0026ndash; 7/31). A fetotomy was performed in 68% of cases of dystocia (49/72). A caesarean section or an extraction was performed in 13.9% (10/72) of the cases. No obstetric procedures were performed in 3 of 72 cases of dystocia (4.2%). These mares died before obstetric care was provided. Nine mares (12.5% \u0026ndash; 9/72) were not discharged alive after dystocia. 73 foals were born in 72 cases of dystocia (one twin pregnancy). 55 foals were already dead before veterinary treatment began. In relation to the total number of births in which the foetus was alive at the start of obstetric care, the foetal mortality rate was 61.1% (11/18) and 88.9% (16/18) by the time the mare was discharged.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIt has been shown for the first time that combined causes of dystocia are more common in horses than isolated causes of dystocia. Neonatal mortality remains high, meaning that the timely detection and treatment of dystocia has the highest priority.\u003c/p\u003e","manuscriptTitle":"Isolated and combined causes of equine dystocia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-08 13:11:07","doi":"10.21203/rs.3.rs-4007597/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7e5b45b0-5bf0-4581-9daf-63979a1c2507","owner":[],"postedDate":"April 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T16:02:35+00:00","versionOfRecord":{"articleIdentity":"rs-4007597","link":"https://doi.org/10.1186/s13028-024-00772-8","journal":{"identity":"acta-veterinaria-scandinavica","isVorOnly":false,"title":"Acta Veterinaria Scandinavica"},"publishedOn":"2024-10-11 15:57:48","publishedOnDateReadable":"October 11th, 2024"},"versionCreatedAt":"2024-04-08 13:11:07","video":"","vorDoi":"10.1186/s13028-024-00772-8","vorDoiUrl":"https://doi.org/10.1186/s13028-024-00772-8","workflowStages":[]},"version":"v1","identity":"rs-4007597","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4007597","identity":"rs-4007597","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}