Staging and Prediction of Parturition in the Mare

Myrthe Wessel, DVM, DACT

Due to the relatively explosive nature of an equine delivery and the associated severe
consequences, it is imperative that immediate assistance can be provided when compli-
cations occur. To be able to supply a certain level of care, it is important to be prepared and
therefore to have a full understanding of the physiology and pathology of parturition. This
article describes the three stages and physiology of parturition in addition to a variety of
instruments that can be used to predict foaling in the mare. Different monitoring systems
will be discussed as well as diagnostic tools and their applicability under physiological and
pathological circumstances.
Clin Tech Equine Pract 4:219-227 2005 Elsevier Inc. All rights reserved.

KEYWORDS prediction of parturition, physiology of parturition, stages of parturition, monitor-

ing parturition, equine

Physiology of Parturition Estrogens

Late pregnant mare urine and blood contain high concentra-
Hormones Progesterone/Progestagens tions of estrogens. The form of estrogens during pregnancy in

I nitially the pregnancy hormone, progesterone, is produced

by the primary corpus luteum (CL) (Figure 1A). If the
embryo has successfully signaled the mares endometrium
not to release prostaglandin, this primary CL will be respon-
sible for progesterone production during the first 35 days of
gestation. A unique feature of the equine allantochorionic
placenta is the formation of endometrial cups. Between days
35 and 40 after ovulation, these cups commence the produc-
tion of equine chorionic gonadotrophin (eCG). Due to its
expression of LH-like and FSH-like biological activity, sec-
ondary follicles from follicular waves luteinize or ovulate.
These secondary corpora lutea will be responsible for a rise in
and maintenance of maternal serum progesterone until ap-
proximately 150 days of gestation. The placenta begins to
produce appreciable amounts of progesterone from around
day 70 of gestation, which is likely to be of maternal origin.
Other progestins, like the biologically active dihydroproges-
terone (5-DHP), predominate throughout the second half
of gestation. Additionally, research has shown that the pre-
cursors (mainly pregnenolone) that are responsible for a pro-
nounced rise in maternal plasma progestagen concentration
during the last 4 to 6 weeks of gestation appear to originate
from the steadily enlarging fetal adrenal gland. This increase
of maternal serum progestagens is finally followed by a sharp
decline only during the immediate preparturient period2,3
(Figure 1B).
Address reprint requests to Dr. Myrthe Wessel, Mirostraat #49, 1328 JP,
Almere, Holland. E-mail: wesseldvm@yahoo.co.uk
the mare is either conjugated (for example estrone-sulfate) or
free (estrone or estradiol). The predominant estrogens during
equine pregnancy are estrone, equilin, equilenin, estradiol
17, and estradiol 17. These estrogens are produced by
placental aromatization of precursors that are secreted by
fetal gonads. Both the testes in male fetuses and the ovaries in
female fetuses go through a significant enlargement from
around day 80 of gestation (Figure 1A). The first rise in
conjugated estrogens is induced by eCG, originating from the
endometrial cups, at day 38 to 40, and is produced by ovar-
ian luteal tissues. Subsequently, a second rise is seen around
day 70, which continues until days 190 to 250 and then
declines throughout the rest of pregnancy to become baseline
at term.
Prostaglandin/Oxytocin/Relaxin
The rise in maternal plasma progestagen concentrations dur-
ing the last weeks of pregnancy is reportedly caused by an
increased stimulation of the fetal adrenal cortex by adreno-
corticotropic hormone (ACTH), which subsequently leads to
production of more pregnenolone for placental metabolism
to 5-reduced progestagens. It is not until 48 hours before
parturition that the fetal adrenals switch from the production
of pregnenolone to cortisol and therefore cause a dramatic
increase in fetal cortisol concentrations concurrent with a
decline in progestagen. These changes in hormone concen-
trations, together with a sharp increase in placental release of
relaxin, initiate the cascade of oxytocin and prostaglandin
releases that drive the cervical relaxation and myometrial
contractions of the delivery. The latter three hormones, re-

1534-7516/05/$-see front matter 2005 Elsevier Inc. All rights reserved. 219
doi:10.1053/j.ctep.2005.07.003
220
Figure 1 (A) Hormonal events during gestation of mares. 1CL, primary corpus luteum; 2CL, secondary corpus
luteum; E. cups, endometrial cups; P, progesterone; E, estrogens; PMSG, pregnant mares serum gonadotropin; FG, fetal
gonads; OV, ovulation and p, parturition. Courtesy of Dr. E.L. Squires.1 (B) Equine gestation hormones. Courtesy of Dr.
D.P. Neeley.4
laxin, oxytocin, and prostaglandin, peak during the second
stage of labor.
Prepartum Changes
The duration of a normal equine pregnancy is quite variable
but generally averages 335 to 342 days. However, normal,
mature foals may be born from mares with a gestational
length of 305 to more than 400 days. A variety of factors seem
to influence gestational length, including fetal gender and the
time of year the mare is foaling.
Activation of the myometrium, an important event during
the onset of labor, appears to be initiated by the changes in
maternal estradiol, progestogen, and relaxin concentrations.
Increased muscle activity in the myometrium has been re-
ported in the last week of pregnancy. In some equids, an
increase in myometrial activity occurs approximately 4 hours
before delivery, whereas in others, an initial decrease in elec-
tromyography activity is followed by an increase at the time
of the rupture of the chorioallantois.5
The fetal position varies greatly during the last month of
gestation from a base position in dorsal recumbency. The
location and range of motion of front limbs and head is quite
extensive as shown in Figure 2.
In response to increasing progestogen concentrations and
decreasing estrogen concentrations, the mares mammary
gland development usually increases 4 to 6 weeks before
parturition and the teats distend with colostrum 2 to 14 days
before parturition. Dried beads of colostrums (waxing of
Parturition in the mare
the teats) may be seen 6 to 48 hours before parturition (Fig-
ure 3). The relaxation of the vulva usually occurs a few hours
before birth, and the reduction in tone of the sacrosciatic
ligaments, possibly due to a gradual increase in relaxin con-
centrations, progresses gradually over the last weeks of preg-
nancy. Cervical softening can be noted well in advance (0-30
days), but complete relaxation and dilation occur during
stage I of parturition.
Stages of Parturition
Stage I
The onset and progress of stage I of parturition can be quite
difficult to determine due to its vague and nonspecific signs.
Sweating of the mare on the flanks and behind the elbows,
restlessness, and signs of colic characterize stage I. The mare
may show the flehmen response, frequently switch of the tail,
and milk may squirt from the teats. These intermittent signs
of discomfort are attributed to rotation of the foal and uterine
contractions. During stage I, the fetus moves from a dorso-
pubic position to a dorso-sacral position with head and front
legs extended. A wedge is formed by the front feet and nose
that assists in cervical dilation (Figure 4). If disturbed, the
mare is able to stop the early stage of parturition, so it is
important to observe without distracting the mare. The du-
ration of stage I averages from 1 to 4 hours, but may not be
obvious in older multiparous mares. The end of stage I is
marked by the rupture of the chorioallantoic membrane and
the release of allantoic fluid.
M. Wessel 221

Figure 2 Positions assumed by the fetus and uterus during the last month of pregnancy, viewed from the mares left side.
The red line represents the horn that contains the hind limbs. The markers on the circles indicate the positions of the
dorsal surface of the uterine body, fetal withers, and fetal tail head as viewed by an operator standing behind the mare.
Courtesy of Dr. O.J. Ginther.

Figure 3 Mare with waxed teats. Dried beads of colostrums are commonly seen at the teat orifice before parturition.
222 Parturition in the mare

Figure 4 Representative rotational positions of fetal parts during parturition, viewed from dorsal aspect of mare. The
axial rotational position is shown on the circles for the dorsal surfaces of the uterus, fetal withers, and fetal tail head
viewed from behind the mare. The relationship of the hind-limb horn to the limbs is shown by a red line representing
the corneal wall. Representative time intervals between positions are shown. Courtesy of Dr. O.J. Ginther.

Stage II
The onset of stage II labor is defined by the rupture of the
chorioallantois. Although most mares lie down during sec-
ond stage labor, it is not uncommon for the mare to sit up or
even walk around before lying down again. Some mares may
even roll to attempt to alleviate discomfort or position the
foal. Often all four of the mares legs may extend during
forceful abdominal contractions, and frequent urination and
defecation may occur. The average duration of stage II is 20 to
30 minutes, and the length of time since allantoic fluid was
released should be noted. Prolonged stage II can indicate a
problem in fetal positioning and the fetus can quite rapidly
become compromised. During stage II, the whitish-blue
amniotic membrane should become visible at the vulva
within 5 to 10 minutes after the rupture of the chorioallan-
tois, which indicates the engagement of the foal into the birth
canal. Once the fetus engages or stretches the cervix, the
Ferguson reflex occurs resulting in strong contractions of the
abdominal muscles and diaphragm together with closure of
the glottis (Figure 5). Frequently, the foal is delivered with an
intact amnion that ruptures spontaneously with the foals
movements. Care should be taken to remove the amniotic
membrane from the nose and mouth if it is still present when
the foal is delivered. The normal posture (the relationship of
the fetal extremities to the fetal trunk) of a fetus during de-
livery is one forelimb extending approximately four inches
cranial to the other extended forelimb with the soles of both
feet directed toward the mares udder (Figure 4). During
stage II, the placenta may start to separate from the mares
endometrium, which likely contributes to the poor survival
rate of foals delivered after a prolonged stage II.5,7
Stage III
The fetal membranes are expelled during stage III of parturi-
tion. Myometrial contractions and mild signs of discomfort
often characterize this last stage. The placenta is normally
passed in less than 3 hours after delivery of the foal. Fetal
membranes retained longer than 3 hours are considered re-
tained, and treatment should be initiated immediately. Ex-
posed fetal membranes should be knotted to prevent damage
to the membranes. Expelled membranes should be evaluated
carefully, noting the presence of both uterine horn tips and
any abnormalities
M. Wessel
Figure 5 Mare in stage II labor. The chorioallantois has already rup-
tured and the white translucent amnion containing amniotic fluid is
seen at the mares vulvar lips.
Monitoring Systems
Due to the relatively explosive nature of equine parturition
and the severe consequences of dystocia, it is imperative that
immediate assistance can be provided when a problem arises.
Unfortunately, it has been shown that most mares foal after
6 PM. A study from Newcombe and coworkers8 demonstrated
a significant effect of activity in the barn on actual time of
parturition. Mares that were housed in a barn with more
activity and people traffic foaled later than the mares that
were housed in a quiet barn. Being able to predict the mares
readiness for birth and time of delivery would allow the ap-
propriate personnel to be present should veterinary interven-
tion be required. A variety of monitoring systems are avail-
able to assist in the detection of parturition. Unfortunately,
no one system is infallible. A description of the methods
available will follow with their applications and limitations
when used in the field.
Gestational Length
Normal gestation length is highly variable between mares
ranging between 320 and 360 days. Several groups have re-
ported an impact of season on gestational length, with mares
foaling during days of longer daylight having a shorter gesta-
tion.9,10 In addition, differences have been reported in gesta-
tional length between mares carrying fetuses from different
gender in that colts tend to be carried a few days longer than
fillies.11 However, these differences are small and have only
223
been investigated in certain breeds. It is therefore imperative
that gestation length alone not be used as a reliable predictor
of foaling date.
Mammary Gland Secretions
Ousey and coworkers12 described a correlation between
mammary secretion electrolyte concentrations and fetal ma-
turity. They found that 24 to 48 hours before foaling, calcium
concentrations increased, whereas the sodium to potassium
ratio in the mammary secretions inverted 3 to 5 days before
birth, with the sodium concentration starting higher than
potassium concentration (Figure 6).
Exact measurement of milk electrolyte concentrations re-
quires a flame spectrophotometer or a laboratory chemistry
analyzer. Elevation of calcium above 40 mg/dL and the in-
version of sodium and potassium concentrations generally
indicate fetal readiness for birth in a normal equine preg-
nancy.
These electrolyte changes commonly occur at night, which
necessitates the availability of stall-side test kits. The dilution
kits, in which titration of a diluted sample induces a color
change of an indicator dye (Titrets, CHEMetrics, Inc., Cal-
verton, VA; Sofcheck, Environmental Test Systems, Elkhart,
IN), appear slightly more labor intensive than the test strips
(Predict-A-Foal, Animal Health Care Products, Vernon,
CA). Many of these kits, however, test for divalent cations,
which include magnesium as well as calcium. An earlier and
slower rise in magnesium makes the results of water hardness
tests, which do not differentiate between magnesium and
calcium, complicated to interpret. Some groups have found
the Titret test kit to be the most reliable commercially
available test for predicting foaling within 24 hours. Using
this kit, Ley and coworkers13,14 found that mares with a cal-
cium carbonate concentration of 200 ppm had a 54%
Figure 6 Milk electrolytes. Calcium concentrations in the mammary
gland secretions increased during the 24 to 48 hours before partu-
rition. The sodium to potassium ratio in mammary secretions in-
verted 5 days before birth.
224 Parturition in the mare

Figure 7 Mare with Birthalarm.

Figure 8 Mare with Breeder Alert.

M. Wessel
probability of foaling within 24 hours, 84% probability of
foaling within 48 hours, and 97% probability of foaling
within 72 hours. Once the CaCo3 concentrations in the mam-
mary secretions reached 300 to 500 ppm, most mares foaled
within a short period of time, and when the CaCo3 levels
were less than 200 ppm, the mare had a less than 1% chance
of foaling within 24 hours of testing. Another factor to con-
sider is the rate of change in the calcium concentration: a
mare that displays a rapid increase over a shorter period of
time is more likely to foal before a mare that shows a gradual
increase in calcium concentrations.
Factors that will influence the reliability of these tests are
placental abnormalities, twin pregnancies, maiden mares,
and the time of sampling. Samples taken early in the day may
not reflect the electrolyte changes that occur later in the day
or at night, when a large percentage of mares foal. In addition,
mares with placental abnormalities or twin pregnancies may
show mammary gland development and changes in mam-
mary gland secretions long before parturition, whereas
maiden mares sometimes wait until the last moment to
demonstrate udder development and colostrum production.
It is therefore important to evaluate each individual mare and
interpret the results of these tests cautiously in mares with
abnormal pregnancies or mares that are foaling for the first
time.15
Blood/Urine/Milk
Hormone profiles can be helpful in determining pregnancy.
However, no reliable test has been developed to predict tim-
ing of parturition with the use of progesterone, estrogens, or
other hormones. Due to the sudden decline in progestogens
immediately before parturition, progestogen measurement in
serum or milk could only be used as an indicator when fre-
quent samples, nearly hours apart, were obtained and evalu-
ated. Serum, fecal, or urine estrogen concentrations can be
Figure 9 Close-up of the Foalert Inc.
225
helpful to assess pregnancy and fetal viability during gesta-
tion. Unfortunately, estrogens are not a useful indicator of
predicting parturition because there is a gradual decline dur-
ing the last trimester of gestation to baseline levels at partu-
rition.
Position Monitoring Systems
Based on the position of the mare during active parturition,
the Birthalarm, the EquiPage, Breeder Alert system,
and other monitors have been designed. To absorb and facil-
itate abdominal contractions, the mare will often stay in lat-
eral recumbency for a large part of the birth process. The
companies that market these monitors hypothesize that this
is an uncommon position for the mare under physiological
conditions during late gestation, and when the mare is in a
fully lateral position for a predetermined amount of time, a
signal will be transmitted and the alarm will be activated.
Based on the assumption that a single contraction does not
last longer than 2.5 minutes, Birthalarm (Figure 7) has an
additional setting for mares that commonly lie in lateral re-
cumbency under normal conditions. The alarm will be acti-
vated if the mare is lying in a totally lateral position for less
than 3 minutes. The halter transmitter systems, like Equi-
Page or Breeder Alert (Figure 8), are based on the same
principal as the previous systems and can be connected to
phones or pagers. The disadvantage of these systems is that
both false negative as false positive alerts occur. A mare that is
frequently in lateral recumbency before foaling will activate
the alarm numerous times, incorrectly. Conversely, if recum-
bency lasts more than 3 minutes, the alarm will not be acti-
vated. The advantages to these systems are that they are rel-
atively safe, noninvasive, and the alarm can be transmitted
over a relatively large area (500 yards or more with a beeper).
226
Figure 10 Foal in breech presentation.
Vulva
Another commonly used foaling monitor is the Foalert, Inc.
system, which consists of a transmitter that is sutured to the
vulva 1 to 2 weeks before expected delivery (Figure 9). When
the vulvar lips physically separate at birth, the actuating mag-
net pulls out of the transmitter, and activates the receiver.
Parturition monitoring can be achieved from a distance with
this relatively noninvasive system.
In the authors experience, this system can be quite useful
when applied correctly. However, malpresentations, malpo-
sitions, or congenital abnormalities of the foal, like breech,
hydrocephalus, and other fetal deformities that prevent the
head and/or limbs from entering the pelvic canal and initiat-
ing the Fergusons reflex, will decrease the efficacy of this
system (Figure 10). If no fetal parts are protruding through
the vulva to disconnect the magnet and transducer, no signal
will be emitted during this (abnormal) delivery. However, it
has been observed that, even in cases where no fetal parts
protrude from the vulva, the amnion alone or sometimes
abdominal contractions will disengage the magnet and acti-
vate the system.
Camera/Continuous Monitoring
A reliable and convenient foaling monitoring system uses a
video camera mounted in the foaling stall to allow the foaling
attendant to unobtrusively observe the mare. Barn camera
options are wired or wireless transmission. Distance and
quality of transmission varies per camera unit and, depend-
ing on the distance and possible obstructions, a wireless barn
camera may or may not be feasible. One important issue to be
aware of is that some wireless camera transmissions use the
same frequency as certain portable phones. If you use that
portable phone, the barn camera transmission is interrupted.
Audiovisual supervision of the mare can enhance detection of
rupture of the chorioallantois, restlessness (stage I), and the
mares vocalizations during contractions. However, continu-
ous monitoring is required.
Parturition in the mare
Summary
The described methods can be useful in predicting when a
mare will foal, when used conscientiously and properly. It
is, however, essential to realize that every case is different
and should be assessed individually. The success rate of
any monitoring system will depend on the facilities that
are available and how the different tools and techniques
are implemented under those circumstances. Although all
methods may not function adequately in all situations,
certain monitoring systems may be beneficial on individ-
ual farms, and a combination of tools may be chosen for a
particular farm.
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