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

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 the teats) may be seen 6 to 48 hours before parturition (Fig-
stage of labor. 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-
Prepartum Changes centrations, progresses gradually over the last weeks of preg-
The duration of a normal equine pregnancy is quite variable nancy. Cervical softening can be noted well in advance (0-30
but generally averages 335 to 342 days. However, normal, days), but complete relaxation and dilation occur during
mature foals may be born from mares with a gestational stage I of parturition.
length of 305 to more than 400 days. A variety of factors seem
to influence gestational length, including fetal gender and the Stages of Parturition
time of year the mare is foaling.
Activation of the myometrium, an important event during Stage I
the onset of labor, appears to be initiated by the changes in The onset and progress of stage I of parturition can be quite
maternal estradiol, progestogen, and relaxin concentrations. difficult to determine due to its vague and nonspecific signs.
Increased muscle activity in the myometrium has been re- Sweating of the mare on the flanks and behind the elbows,
ported in the last week of pregnancy. In some equids, an restlessness, and signs of colic characterize stage I. The mare
increase in myometrial activity occurs approximately 4 hours may show the flehmen response, frequently switch of the tail,
before delivery, whereas in others, an initial decrease in elec- and milk may squirt from the teats. These intermittent signs
tromyography activity is followed by an increase at the time of discomfort are attributed to rotation of the foal and uterine
of the rupture of the chorioallantois.5 contractions. During stage I, the fetus moves from a dorso-
The fetal position varies greatly during the last month of pubic position to a dorso-sacral position with head and front
gestation from a base position in dorsal recumbency. The legs extended. A wedge is formed by the front feet and nose
location and range of motion of front limbs and head is quite that assists in cervical dilation (Figure 4). If disturbed, the
extensive as shown in Figure 2. mare is able to stop the early stage of parturition, so it is
In response to increasing progestogen concentrations and important to observe without distracting the mare. The du-
decreasing estrogen concentrations, the mares mammary ration of stage I averages from 1 to 4 hours, but may not be
gland development usually increases 4 to 6 weeks before obvious in older multiparous mares. The end of stage I is
parturition and the teats distend with colostrum 2 to 14 days marked by the rupture of the chorioallantoic membrane and
before parturition. Dried beads of colostrums (waxing of 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 membrane from the nose and mouth if it is still present when
The onset of stage II labor is defined by the rupture of the the foal is delivered. The normal posture (the relationship of
chorioallantois. Although most mares lie down during sec- the fetal extremities to the fetal trunk) of a fetus during de-
ond stage labor, it is not uncommon for the mare to sit up or livery is one forelimb extending approximately four inches
even walk around before lying down again. Some mares may cranial to the other extended forelimb with the soles of both
even roll to attempt to alleviate discomfort or position the feet directed toward the mares udder (Figure 4). During
foal. Often all four of the mares legs may extend during stage II, the placenta may start to separate from the mares
forceful abdominal contractions, and frequent urination and endometrium, which likely contributes to the poor survival
defecation may occur. The average duration of stage II is 20 to rate of foals delivered after a prolonged stage II.5,7
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
Stage III
become compromised. During stage II, the whitish-blue The fetal membranes are expelled during stage III of parturi-
amniotic membrane should become visible at the vulva tion. Myometrial contractions and mild signs of discomfort
within 5 to 10 minutes after the rupture of the chorioallan- often characterize this last stage. The placenta is normally
tois, which indicates the engagement of the foal into the birth passed in less than 3 hours after delivery of the foal. Fetal
canal. Once the fetus engages or stretches the cervix, the membranes retained longer than 3 hours are considered re-
Ferguson reflex occurs resulting in strong contractions of the tained, and treatment should be initiated immediately. Ex-
abdominal muscles and diaphragm together with closure of posed fetal membranes should be knotted to prevent damage
the glottis (Figure 5). Frequently, the foal is delivered with an to the membranes. Expelled membranes should be evaluated
intact amnion that ruptures spontaneously with the foals carefully, noting the presence of both uterine horn tips and
movements. Care should be taken to remove the amniotic any abnormalities
M. Wessel 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
Figure 5 Mare in stage II labor. The chorioallantois has already rup-
tured and the white translucent amnion containing amniotic fluid is
calcium, complicated to interpret. Some groups have found
seen at the mares vulvar lips. 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-
Monitoring Systems cium carbonate concentration of 200 ppm had a 54%

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- Figure 6 Milk electrolytes. Calcium concentrations in the mammary
tional length between mares carrying fetuses from different gland secretions increased during the 24 to 48 hours before partu-
gender in that colts tend to be carried a few days longer than rition. The sodium to potassium ratio in mammary secretions in-
fillies.11 However, these differences are small and have only verted 5 days before birth.
224 Parturition in the mare

Figure 7 Mare with Birthalarm.

Figure 8 Mare with Breeder Alert.

M. Wessel 225

probability of foaling within 24 hours, 84% probability of helpful to assess pregnancy and fetal viability during gesta-
foaling within 48 hours, and 97% probability of foaling tion. Unfortunately, estrogens are not a useful indicator of
within 72 hours. Once the CaCo3 concentrations in the mam- predicting parturition because there is a gradual decline dur-
mary secretions reached 300 to 500 ppm, most mares foaled ing the last trimester of gestation to baseline levels at partu-
within a short period of time, and when the CaCo3 levels rition.
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 Position Monitoring Systems
mare that displays a rapid increase over a shorter period of Based on the position of the mare during active parturition,
time is more likely to foal before a mare that shows a gradual the Birthalarm, the EquiPage, Breeder Alert system,
increase in calcium concentrations. and other monitors have been designed. To absorb and facil-
Factors that will influence the reliability of these tests are itate abdominal contractions, the mare will often stay in lat-
placental abnormalities, twin pregnancies, maiden mares, eral recumbency for a large part of the birth process. The
and the time of sampling. Samples taken early in the day may companies that market these monitors hypothesize that this
not reflect the electrolyte changes that occur later in the day is an uncommon position for the mare under physiological
or at night, when a large percentage of mares foal. In addition,
conditions during late gestation, and when the mare is in a
mares with placental abnormalities or twin pregnancies may
fully lateral position for a predetermined amount of time, a
show mammary gland development and changes in mam-
signal will be transmitted and the alarm will be activated.
mary gland secretions long before parturition, whereas
Based on the assumption that a single contraction does not
maiden mares sometimes wait until the last moment to
demonstrate udder development and colostrum production. last longer than 2.5 minutes, Birthalarm (Figure 7) has an
It is therefore important to evaluate each individual mare and additional setting for mares that commonly lie in lateral re-
interpret the results of these tests cautiously in mares with cumbency under normal conditions. The alarm will be acti-
abnormal pregnancies or mares that are foaling for the first vated if the mare is lying in a totally lateral position for less
time.15 than 3 minutes. The halter transmitter systems, like Equi-
Page or Breeder Alert (Figure 8), are based on the same
Blood/Urine/Milk principal as the previous systems and can be connected to
Hormone profiles can be helpful in determining pregnancy. phones or pagers. The disadvantage of these systems is that
However, no reliable test has been developed to predict tim- both false negative as false positive alerts occur. A mare that is
ing of parturition with the use of progesterone, estrogens, or frequently in lateral recumbency before foaling will activate
other hormones. Due to the sudden decline in progestogens the alarm numerous times, incorrectly. Conversely, if recum-
immediately before parturition, progestogen measurement in bency lasts more than 3 minutes, the alarm will not be acti-
serum or milk could only be used as an indicator when fre- vated. The advantages to these systems are that they are rel-
quent samples, nearly hours apart, were obtained and evalu- atively safe, noninvasive, and the alarm can be transmitted
ated. Serum, fecal, or urine estrogen concentrations can be over a relatively large area (500 yards or more with a beeper).

Figure 9 Close-up of the Foalert Inc.

226 Parturition in the mare

Figure 10 Foal in breech presentation.

Vulva Summary
Another commonly used foaling monitor is the Foalert, Inc.
The described methods can be useful in predicting when a
system, which consists of a transmitter that is sutured to the
mare will foal, when used conscientiously and properly. It
vulva 1 to 2 weeks before expected delivery (Figure 9). When
is, however, essential to realize that every case is different
the vulvar lips physically separate at birth, the actuating mag-
and should be assessed individually. The success rate of
net pulls out of the transmitter, and activates the receiver.
Parturition monitoring can be achieved from a distance with any monitoring system will depend on the facilities that
this relatively noninvasive system. are available and how the different tools and techniques
In the authors experience, this system can be quite useful are implemented under those circumstances. Although all
when applied correctly. However, malpresentations, malpo- methods may not function adequately in all situations,
sitions, or congenital abnormalities of the foal, like breech, certain monitoring systems may be beneficial on individ-
hydrocephalus, and other fetal deformities that prevent the ual farms, and a combination of tools may be chosen for a
head and/or limbs from entering the pelvic canal and initiat- particular farm.
ing the Fergusons reflex, will decrease the efficacy of this
system (Figure 10). If no fetal parts are protruding through References
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will be emitted during this (abnormal) delivery. However, it (eds): Equine Reproduction. Philadelphia, PA, Lea & Febiger, 1993, pp
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protrude from the vulva, the amnion alone or sometimes 2. Allen WR: The physiology of later pregnancy in the mare. 2000 Pro-
abdominal contractions will disengage the magnet and acti- ceedings of the Annual Conference of the Society for Theriogenology,
San Antonio, TX, November 11December 2, 2000, pp 3-15
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to know about progestins and estrogens. Proceedings of the Annual
Conference of the Society for Theriogenology, Lexington, KY, August
Camera/Continuous Monitoring 4-7, 2004, pp 106-115
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