Norton J Lynch, Dallap B L, Johnston J K, Palmer J E, Sertich P L, Boston R, Wilkins P A
Department of Clinical Studies, Section of Large Animal Medicine, University of Pennsylvania, School of Veterinary Medicine, George D. Widener Hospital for Large Animals, New Bolton Center, Kennett Square, Pennsylvania 19348, USA.
Equine Vet J. 2007 Jan;39(1):37-41. doi: 10.2746/042516407x165414.
The period between the onset of dystocia and its resolution has an important bearing on fetal outcome. There are few published data on which to base decisions regarding optimum management of cases in practice.
To evaluate and compare the effects of a coordinated dystocia management protocol (CDMP) with that of a previous protocol of random management on time to resolution and outcome in both an emergency dystocia referral population of mares (referred emergency cases: EM) and in a population of mares residing in hospital due to high risk pregnancy (HRP) concerns that then experience dystocia at parturition.
Retrospective study performed at a university hospital referral centre of cases presenting from 1991-2004 divided into Group 1 (pre-CDMP) and Group 2 (CDMP).
Medical records of 71 cases with dystocia were retrieved and data recorded. For referred emergency cases (EM), time from hospital presentation to resolution decreased significantly by 32 min (P = 0.03) after institution of CDMP. Survival rate of mares at discharge was 86%. Survival of EM foals was low, with 10% in Group 1 and 13% in Group 2, surviving to discharge. For EM foals delivered alive, survival to discharge was 30% and 43% in Groups 1 and 2, respectively. Median Stage II was significantly (P < 0.001) different at 71 and 282 min for EM foals delivered alive vs. those not alive at delivery, respectively. Median duration of Stage II was also significantly (P < 0.001) different between EM foals surviving and not surviving to discharge, at 44 and 249 min, respectively. Survival of HRP dystocia foals to discharge was 79%.
Although CDMP reduced the time from presentation at the hospital to resolution significantly for EM, total duration of Stage II for EM was unchanged, as was foal outcome.
Very early referral of mares with dystocia to referral centres with dystocia management protocols may improve fetal outcome as increased duration of Stage II in the horse affects fetal outcome negatively.
难产开始至解决的这段时间对胎儿结局有重要影响。关于在实际中对病例进行最佳管理的决策，几乎没有公开数据可供依据。
评估并比较协调难产管理方案（CDMP）与先前随机管理方案对母马紧急难产转诊群体（转诊紧急病例：EM）以及因高危妊娠而住院随后在分娩时发生难产的母马群体在解决时间和结局方面的影响。
在一所大学医院转诊中心对1991年至2004年呈现的病例进行回顾性研究，分为第1组（CDMP之前）和第2组（CDMP）。
检索了71例难产病例的医疗记录并记录数据。对于转诊紧急病例（EM），实施CDMP后，从入院到解决的时间显著减少了32分钟（P = 0.03）。母马出院时的存活率为86%。EM驹的存活率较低，第1组为10%，第2组为13%存活至出院。对于存活出生的EM驹，第1组和第2组出院时的存活率分别为30%和43%。存活出生的EM驹与出生时未存活的EM驹相比，第二产程中位数分别为71分钟和282分钟，差异显著（P < 0.001）。存活至出院和未存活至出院的EM驹第二产程的中位数也有显著差异（P < 0.001），分别为44分钟和249分钟。高危妊娠难产驹出院时的存活率为79%。
尽管CDMP显著缩短了EM从入院到解决的时间，但EM的第二产程总时长未变，驹的结局也未改变。
难产母马尽早转诊至有难产管理方案的转诊中心可能会改善胎儿结局，因为马的第二产程延长会对胎儿结局产生负面影响。
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