Sonographic appearance of the late gestation equine fetal intestine

Abstract

Variable gestation length in the mare poses a challenge for determination of fetal readiness for birth. The objectives of this study were to describe sonographic characteristics of the fetal GI tract in the late gestation mare and identify changes that occur with progressing fetal maturity. Based on these characteristics, a grading scale modeled after the existing human and canine scoring system was developed. Weekly sonographic examination of the fetus by one observer beginning 2–3 weeks prior to a calculated due date of 330 days was performed. Fetal assessment included; presence of stomach rugae, bowel segment definition (uniform echogenic, some defined, clearly defined), bowel segment dilation (none, segmental dilation), intestinal contents (none, mixed echogenicity) and peristalsis (none, occasional, every 3 s, continuous). Based on these characteristics a phase was assigned to the GI tract (1–5). Phase 1 was defined as a uniform echogenic grey area caudal to the diaphragm. The differentiation of Phase 2–5 was based primarily on the frequency of peristalsis, with Phase 2 exhibiting no peristalsis, Phase 3 exhibiting occasional peristalsis, Phase 4 exhibiting peristalsis every 3 s and Phase 5 exhibiting continuous peristalsis. Only data from mares with a normal parturition and healthy foals were included in the statistics (N = 10). Associations amongst sonographic fetal GI characteristics and days prepartum were validated using a simulation-based bootstrap approach with 1000 replicates using Stata 14. Stomach rugae, peristalsis, intestinal contents, tail head relaxation and udder development were all highly correlated with days prepartum. Using a multiple linear regression model, tail head relaxation and peristalsis predicted days prepartum with a 95% CI ± 6 days. The same model predicted days prepartum with a 95% CI ± 4 days when day of gestation, tail head relaxation and peristalsis were included as variables. Based on these findings, characterization of the fetal GI tract could provide valuable information concerning the maturity of the equine fetus. Further studies are needed comparing high risk mares to normal mares before this information could be used with confidence in the clinical setting.