Retained Placenta in Horses: What to Do and When It Is an Emergency
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Retained Placenta in Horses: What to Do and When It Is an Emergency
By Dr Duncan Houston
A mare may look comfortable after foaling while part of the placenta remains firmly attached inside the uterus.
That is what makes a retained placenta dangerous. The visible membranes may be hanging from the vulva, only a small internal fragment may remain, or the placenta may appear to have passed without anyone checking whether it was complete.
A retained placenta is time-sensitive, but it is usually treatable when recognised early. The key is to record the foaling time, avoid pulling on the membranes and involve your veterinarian before the mare becomes systemically unwell.
Quick Answer
The placenta should normally be completely expelled within three hours after the foal is born. If it has not passed by then, or you are unsure whether it is complete, contact your veterinarian immediately.
Do not pull, cut or attach weights to the placenta. Retained tissue can lead to toxic metritis, endotoxaemia, laminitis, peritonitis and, in severe cases, death. Prompt treatment usually gives the mare a good chance of full recovery and future fertility. (Merck Veterinary Manual)
When Is This an Emergency?
A placenta that remains attached for three hours is already considered retained and requires veterinary attention.
Seek emergency assistance sooner if the mare develops:
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Severe or persistent colic
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Marked depression or weakness
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Refusal to eat
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Fever
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Rapid heart rate or breathing
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Dark red, injected, pale or tacky gums
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Foul-smelling vulvar discharge
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Heavy bleeding
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Increasing digital pulses
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Hot or painful feet
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Short, stiff steps or reluctance to turn
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Repeated weight shifting
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Weakness, trembling or collapse
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A large red mass protruding from the vulva
A large fleshy mass rather than thin membranes may be a uterine prolapse, which is an immediate life-threatening emergency. Do not try to replace it yourself. Keep it clean and supported while veterinary help is obtained. (Merck Veterinary Manual)
What Is a Retained Placenta?
The term “retained placenta” is commonly used, although retained fetal membranes is more technically accurate.
The fetal membranes include the:
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Chorioallantois
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Amnion
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Umbilical cord
The chorioallantois is the large, velvety membrane attached across almost the entire inside of the mare’s uterus during pregnancy. After the foal is delivered, its microscopic villi should separate from the uterine lining, the membranes invert through the cervical opening and the placenta should be expelled intact. (Faculty of Science)
Retention can be:
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Complete, with most or all of the membranes still attached
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Partial, with most of the placenta passed but a section remaining
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Hidden, with the retained piece entirely inside the uterus
Partial retention is not necessarily safer. The tip of the previously non-pregnant uterine horn is a common area to remain attached, and this small missing section can be difficult to recognise unless the expelled placenta is carefully examined. (Merck Veterinary Manual)
How Long Should the Placenta Take to Pass?
Equine fetal membranes normally pass within the first three hours after foaling.
Some mares remain clinically well despite retaining the placenta for longer, but this is not a reason to wait. Three hours is the action threshold because serious complications can develop before the mare looks obviously ill. (Merck Veterinary Manual)
A practical plan is:
| Time after foaling | What to do |
|---|---|
| First hour | Record the time and observe without pulling |
| By two hours | Confirm whether separation is progressing and alert your veterinarian if it remains firmly attached |
| At three hours | Treat as retained and arrange veterinary examination |
| Any time the mare becomes unwell | Seek emergency care immediately |
High-risk mares may need veterinary intervention before three hours, particularly after dystocia, caesarean section, abortion, placentitis or a previous retained placenta.
Is There an Eight-Hour Cut-Off?
There is no magical point at eight hours when a safe placenta suddenly becomes dangerous.
Some older protocols introduce additional medication at eight hours, while other current guidelines recommend systemic antimicrobial treatment when membranes remain beyond 12 hours or metritis is suspected. Treatment decisions vary because they depend on the mare, foaling history, membrane condition and whether systemic illness has begun. (Merck Veterinary Manual)
The clinically useful rule is:
Call at three hours. Do not wait for eight or twelve hours before seeking help.
The duration of retention influences risk and treatment, but there is no single later time point that replaces early assessment.
Why Is a Retained Placenta Dangerous?
Retained placental tissue begins to degenerate within the warm postpartum uterus.
This tissue can provide an ideal environment for bacterial growth. Inflammation, fluid and bacterial products may then accumulate within the uterus, leading to:
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Endometritis
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Acute postpartum metritis
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Endotoxaemia
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Septicaemia
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Peritonitis
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Laminitis
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Delayed uterine involution
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Reproductive tract damage
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Death in severe cases
Bacterial toxins can enter the circulation before the mare develops dramatic external signs. Laminitis may then develop as part of the systemic inflammatory response. (Faculty of Science)
The real concern is not simply that tissue remains attached. It is what can happen when that tissue degenerates and the inflammatory response spreads beyond the uterus.
Which Mares Are Most at Risk?
Retained fetal membranes occur in approximately 2% to 11% of light-breed foalings, although prevalence varies significantly between populations.
Reported risk factors include:
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Dystocia
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Caesarean delivery
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Fetotomy
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Placentitis
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Abortion
-
Short or prolonged gestation
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Uterine atony
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Hydrops or excessive fetal fluid
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Advanced mare age
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Previous retained placenta
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Certain heavy or draft breeds
Friesian mares are particularly predisposed, with rates reported much higher than those seen in many light breeds. (Merck Veterinary Manual)
A completely normal-looking foaling does not eliminate the risk. Some mares retain their placenta despite an uncomplicated pregnancy and rapid delivery.
What Does a Retained Placenta Look Like?
The most obvious presentation is a dark red-brown membrane hanging from the vulva.
It may:
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Reach below the hocks
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Drag on the bedding
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Remain partly inside the mare
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Become twisted
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Tear when the mare steps on it
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Appear to shorten as some sections detach
A mare may show mild temporary discomfort as the uterus contracts, but she should remain bright, interested in the foal and able to eat and drink.
More concerning findings include:
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Membranes remaining firmly attached beyond three hours
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Repeated severe straining
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Persistent colic
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Increasing depression
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Foul-smelling fluid
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Fever
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Reduced milk production
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A foal unable to nurse because the mare is uncomfortable
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Stronger digital pulses or foot soreness
Can the Placenta Be Retained Without Anything Hanging Out?
Yes.
Most of the placenta may pass while a small section remains inside the uterus. This is frequently the tip of the non-pregnant horn.
A mare with an unnoticed retained fragment may appear normal initially and then become ill 24 to 48 hours later with:
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Dullness
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Fever
-
Reduced appetite
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Foul vulvar discharge
-
Increased heart rate
-
Injected gums
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Stronger digital pulses
-
Early laminitis
Any postpartum mare developing these signs should be assessed for retained tissue and metritis even if the placenta was believed to have passed. (Faculty of Science)
How Worried Should You Be?
Normal Postpartum Progress
The placenta:
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Passes completely within three hours
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Is available for examination
-
Appears intact
The mare:
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Is bright and attentive
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Is eating and drinking
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Allows the foal to nurse
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Has no fever, severe colic or abnormal discharge
What to do: save the placenta for inspection and continue routine postpartum monitoring.
Concerning
The placenta:
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Has not passed by approximately two hours
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Remains firmly attached
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Has torn or become contaminated
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Cannot be found after an unattended foaling
The mare otherwise appears comfortable.
What to do: contact your veterinarian and prepare for assessment. Do not pull on the membranes.
High Risk
The placenta:
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Remains after three hours
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Appears incomplete
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Was retained after dystocia, abortion or caesarean section
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Is associated with a high-risk mare or previous history
What to do: veterinary treatment should begin promptly.
Critical
The mare develops:
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Fever or depression
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Foul discharge
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Severe colic
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Abnormal gums
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Rapid heart rate
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Weakness
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Painful feet or bounding digital pulses
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Collapse
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A prolapsed uterus
What to do: this is an immediate emergency. Hospital referral and intensive treatment may be required.
What Should You Do Right Now?
1. Record the Time of Foaling
Write down:
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When active labour began
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When the foal was delivered
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When the placenta began appearing
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When it passed, if it does
“Somewhere around midnight” becomes surprisingly unhelpful when deciding whether the placenta has been retained for two hours or eight.
2. Call Your Veterinarian
Call immediately if:
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Three hours have passed
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The placenta appears torn or incomplete
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The foaling was difficult
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The mare is unwell
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The placenta cannot be located
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You are unsure what you are seeing
A high-risk mare should have a pre-arranged postpartum plan with the attending veterinarian.
3. Do Not Pull
Do not apply sustained traction or attempt to peel the membranes away from the uterus.
Forceful removal can cause:
-
Tearing of the placenta
-
Retained membrane fragments
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Endometrial haemorrhage
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Uterine injury
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Inversion of a uterine horn
-
Uterine prolapse
Veterinary manual removal is controversial and may be used selectively by experienced clinicians, but owner traction is unsafe. (Merck Veterinary Manual)
4. Do Not Attach Weights
Never tie a brick, bottle, shoe or other weight to the placenta.
More traction does not mean faster safe separation. It increases the risk of tearing the membranes or damaging the reproductive tract.
5. Prevent the Mare From Stepping on It
If the mare is calm and it can be done safely, the hanging membranes may be loosely folded or tied into a knot above the hocks so they cannot be trampled.
Do not shorten them by cutting them unless the veterinarian specifically directs you to do so. The hanging membranes provide gentle natural traction and help show whether expulsion is progressing. (Faculty of Science)
6. Keep the Mare and Foal Supervised
A mare irritated by membranes around her hindlimbs may kick or move suddenly.
Keep the foal away from the hanging tissue and make sure it can continue nursing safely.
7. Monitor the Mare
If safe, record:
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Rectal temperature
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Heart rate
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Respiratory rate
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Gum colour and moisture
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Appetite
-
Water intake
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Manure
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Urination
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Digital pulses
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Hoof temperature
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Degree of abdominal discomfort
Repeat these checks as directed by your veterinarian.
8. Do Not Administer Oxytocin Yourself
Oxytocin is the most common first-line veterinary treatment, but dose and timing matter.
Excessive oxytocin can produce painful uterine spasm and colic-like signs. It may also be inappropriate if another postpartum complication, such as uterine prolapse, is present. (Faculty of Science)
Use it only under direct veterinary instruction within a pre-established protocol.
9. Do Not Put Anything Into the Uterus
Do not insert:
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A hose
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A hand
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Antiseptic
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Medication
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Oil
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A homemade lavage tube
Postpartum uterine procedures require appropriate restraint, hygiene, examination and knowledge of the reproductive tract.
How Should the Placenta Be Examined?
The placenta should never be discarded before it has been checked.
Once expelled, place it in a clean bag, bucket or container and keep it available for the veterinarian. Photograph it if examination will be delayed.
An intact chorioallantois can be laid out in an F shape:
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The body of the uterus forms the long section.
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The two uterine horns form the arms.
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The cervical star is at the lower end.
-
The umbilical cord attaches near the base of the pregnant horn.
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The amnion should also be present.
The veterinarian will pay particular attention to the tip of the non-pregnant horn because this is a common retained section. Torn edges may sometimes be reconstructed by following the placental blood vessels. (Faculty of Science)
The placenta may also reveal evidence of:
-
Placentitis
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Thickening
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Abnormal colour
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Areas without normal villi
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Premature placental separation
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Umbilical abnormalities
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Meconium staining
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Tearing or missing tissue
A placenta that appears mostly complete can still be missing the one section that matters.
How Do Vets Diagnose Retained Fetal Membranes?
When membranes remain visible, the diagnosis may be obvious.
If partial retention or metritis is suspected, the examination may include:
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General physical examination
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Rectal temperature and heart rate
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Gum assessment
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Digital pulse and hoof examination
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Transrectal palpation of the uterus
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Transrectal ultrasonography
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Vaginal and cervical examination
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Blood count and biochemistry
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Lactate or other perfusion measurements
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Assessment of the expelled placenta
Ultrasound can assess uterine tone, involution, fluid volume, fluid appearance and possible tags of retained membrane. Vaginal examination can identify tissue remaining in the cervix or uterus and characterise the discharge. (Faculty of Science)
Routine culture is not always useful immediately because the postpartum tract is heavily contaminated. Culture and cytology become more valuable when metritis persists or secondary endometritis is suspected. (Faculty of Science)
How Is a Retained Placenta Treated?
There is no single method proven best for every mare.
Treatment is selected according to:
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Duration of retention
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Whether the membranes are intact
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Degree of attachment
-
Mare breed and history
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Dystocia or caesarean delivery
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Presence of metritis or endotoxaemia
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Veterinary experience
-
Response to initial treatment
Current reviews continue to emphasise that treatment approaches vary and that refractory cases can remain challenging. (BVA Journals)
Oxytocin
Oxytocin stimulates uterine contractions and is usually the first veterinary treatment.
The veterinarian may use:
-
Small repeated injections
-
A slow intravenous infusion
-
Oxytocin combined with uterine lavage
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Additional calcium in selected mares
Small, appropriately timed doses are generally preferred because larger doses can cause painful, ineffective uterine spasm.
Many early uncomplicated cases respond to oxytocin alone. (Merck Veterinary Manual)
Calcium
Low calcium concentrations have been associated with retained fetal membranes in some mares, particularly Friesians.
The veterinarian may assess whether intravenous calcium is appropriate when uterine contractility appears poor or the mare belongs to a predisposed population. Calcium treatment requires monitoring because incorrect intravenous administration can affect the heart. (Merck Veterinary Manual)
The Burns Technique
When the membranes remain intact, a veterinarian may use the Burns technique.
Fluid is carefully infused into the space within the chorioallantois, causing it to expand. This can encourage the microscopic placental attachments to release more evenly from the uterine lining.
The fluid is maintained temporarily while the membranes detach. This method avoids pulling directly on the uterine surface but requires intact membranes and trained handling. (Merck Veterinary Manual)
Uterine Lavage
Large-volume uterine lavage may be used to:
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Encourage separation
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Remove bacteria
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Remove inflammatory products
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Clear fluid and debris
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Support uterine involution
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Reduce the risk of metritis
Lavage is particularly important when retention has been prolonged, the membranes are torn or the uterus contains contaminated fluid. The lavage is generally repeated until the returning fluid becomes clear or lightly blood-tinged. (Faculty of Science)
Lavage following a caesarean section requires particular caution because excessive uterine distension may place stress on the surgical closure. (Faculty of Science)
Controlled Manual Removal
Veterinary opinion regarding manual removal varies.
An experienced veterinarian may apply gentle controlled traction or separate tissue that has already loosened. Forceful peeling of firmly attached membranes is avoided because it may:
-
Damage the endometrium
-
Cause haemorrhage
-
Tear the placenta
-
Leave retained tags
-
Invert the uterine horn
-
Cause uterine prolapse
The owner should never attempt manual separation. (Merck Veterinary Manual)
Antimicrobials
Not every bright mare at the three-hour point automatically requires broad-spectrum antibiotics.
Systemic antimicrobials become more likely when:
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Retention is prolonged
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Metritis is suspected
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The mare has fever or depression
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The discharge is foul
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Significant contamination is present
-
Manual removal has been necessary
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Endotoxaemia or sepsis is developing
Current antimicrobial guidance favours systemic treatment when metritis is suspected or the placenta has remained beyond approximately 12 hours. Immediate intrauterine antibiotics are not routinely recommended because lavage and uterine clearance are more important early, and some intrauterine products may irritate the endometrium. (Faculty of Science)
The exact antibiotic decision depends on the mare and local antimicrobial stewardship guidance.
Anti-Inflammatory and Endotoxin Treatment
Veterinary treatment may also include:
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Non-steroidal anti-inflammatory medication
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Intravenous fluids
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Endotoxin-directed treatment
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Cardiovascular support
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Gastrointestinal monitoring
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Pain management
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Tetanus prophylaxis when vaccination status is uncertain
The aim is to control systemic inflammation before it progresses to shock or laminitis. (Faculty of Science)
Does the Mare Need Exercise?
Once the mare is stable and the veterinarian considers movement safe, quiet paddock turnout or controlled walking may support uterine clearance and involution.
Exercise is not appropriate when the mare is:
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Systemically unwell
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Bleeding
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Showing significant colic
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Footsore
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Developing laminitis
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Recovering from a procedure requiring confinement
Movement should support treatment, not become another stress test for a sick postpartum mare. (Faculty of Science)
How Is Laminitis Prevented?
Laminitis is one of the most feared complications of toxic metritis and endotoxaemia.
Prevention may include:
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Rapid removal or expulsion of retained tissue
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Uterine lavage
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Control of metritis
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Anti-inflammatory treatment
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Endotoxin-directed therapy
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Intravenous fluids
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Continuous digital hypothermia
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Frequent digital-pulse and gait monitoring
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Early hoof support where indicated
Continuous Digital Hypothermia
Continuous cooling of the feet and lower limbs is most effective when started before laminitis becomes clinically obvious.
Evidence from experimental studies and clinical populations with systemic inflammatory disease supports continuous digital hypothermia as a way to reduce the development or severity of lamellar injury. The retained-placenta-specific evidence is limited, so its use is based on the recognised endotoxaemia risk and the broader evidence for sepsis-associated laminitis. (veterinaryevidence.org)
The veterinarian may recommend cooling:
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All four feet
-
Continuously rather than intermittently
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Using ice-water boots, tubs or purpose-designed devices
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For as long as the systemic laminitis risk remains significant
There is no universal rule that every mare must be iced for exactly two or three days. Duration depends on placental retention, metritis, blood results, digital pulses and the mare’s response.
Do Not Wait for Foot Pain
Cryotherapy provides the greatest protective value when started early.
Once the mare is already reluctant to move or has bounding digital pulses, lamellar damage may be underway. Early cooling is prevention, not merely pain relief. (veterinaryevidence.org)
Early Signs of Laminitis
Check the mare for:
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Stronger digital pulses
-
Increased hoof heat
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Shortened stride
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Reluctance to turn
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Weight shifting
-
Walking as though the ground is painful
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Repeated lying down
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A rocked-back stance
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Refusal to walk
Do not repeatedly trot a recently foaled mare to see whether she is lame.
If laminitis is suspected, keep her on deep supportive bedding, minimise movement and seek urgent veterinary treatment.
What Else Can Look Like a Retained Placenta Complication?
Not every postpartum problem is caused solely by retained membranes.
Important differentials and associated complications include:
Normal Postpartum Uterine Contractions
Brief mild colic-like behaviour may occur while the uterus contracts and the placenta separates.
Persistent or severe pain is not normal.
Gastrointestinal Colic
A postpartum mare can develop gas colic, impaction, displacement or another gastrointestinal problem independently of the reproductive tract.
Postpartum Haemorrhage
Internal bleeding from a uterine or ovarian artery may cause:
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Sudden colic
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Pale gums
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Weakness
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Sweating
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Rapid heart rate
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Collapse
There may be little or no external bleeding.
Uterine Tear or Reproductive Tract Trauma
Dystocia can cause cervical, vaginal or uterine damage. Fever, abdominal pain, depression and shock may develop.
Uterine Prolapse
This presents as a large, fleshy red mass rather than thin membranes and requires immediate replacement by a veterinarian. (Merck Veterinary Manual)
Postpartum Metritis Without Visible Membranes
Retained placental microvilli or foaling trauma may allow bacterial proliferation even when no obvious tissue is hanging from the vulva. Postpartum metritis often develops during the first several days after foaling. (Merck Veterinary Manual)
Normal Lochia vs Abnormal Discharge
A small amount of postpartum uterine discharge may occur.
Discharge becomes concerning when it is:
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Foul-smelling
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Thick or pus-like
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Dark and excessive
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Associated with fever
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Accompanied by depression or poor appetite
What Happens After the Placenta Passes?
Passing the placenta does not automatically end the risk.
The veterinarian may still recommend:
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Examination of the membranes
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Uterine palpation or ultrasound
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Uterine lavage
-
Additional oxytocin
-
Anti-inflammatory medication
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Antibiotics where indicated
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Blood tests
-
Laminitis prevention
-
Continued temperature monitoring
The mare should be observed closely for at least the next several days because metritis, endotoxaemia or laminitis may become apparent after the membranes have passed.
Postpartum Monitoring Checklist
Check at least twice daily, or more frequently when directed:
-
Rectal temperature
-
Appetite
-
Water intake
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Attitude
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Heart rate
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Gum colour
-
Vulvar discharge
-
Milk production
-
Nursing behaviour
-
Manure and urine
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Digital pulses
-
Hoof temperature
-
Willingness to walk and turn
Seek reassessment if anything worsens over hours rather than improving.
Common Mistakes Horse Owners Make
Waiting Until Eight Hours
Three hours is the recognised threshold for retained fetal membranes. Do not wait for a later cut-off before calling.
Pulling on the Placenta
Forceful traction can tear the membranes and damage the uterus.
Tying a Weight to the Membranes
This creates uncontrolled traction and can cause serious injury.
Cutting Off the Hanging Portion
Cutting removes the natural dependent weight, may hide whether separation is progressing and can make the remaining tissue harder to monitor.
Assuming Most of the Placenta Is Good Enough
A small retained horn tip can still cause serious complications.
Throwing the Placenta Away
The expelled membranes contain valuable information about the mare, pregnancy and foal.
Giving Oxytocin Without Veterinary Direction
Incorrect dosing can cause severe uterine cramping and may be unsafe when another postpartum complication is present.
Stopping Monitoring Once It Passes
Metritis and laminitis can develop after placental expulsion, particularly following prolonged retention.
Waiting for the Classic Laminitis Stance
Digital pulses, short steps and reluctance to turn may appear before the mare rocks back dramatically.
Can Retained Placenta Be Prevented?
Not every case can be prevented.
Risk reduction focuses on preparation and rapid response:
-
Identify mares with a previous retained placenta.
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Recognise Friesian and heavy draft predisposition.
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Investigate and manage placentitis.
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Have experienced assistance available for dystocia.
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Refer high-risk pregnancies before foaling where appropriate.
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Attend or closely monitor every foaling.
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Record the delivery time.
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Save and inspect every placenta.
-
Maintain current tetanus vaccination.
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Prepare veterinary contact and transport details.
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Keep cryotherapy equipment available for high-risk mares.
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Establish an early postpartum oxytocin plan with the veterinarian where indicated.
Supplements should not be added blindly in an attempt to prevent retention. The nutritional and biological causes are complex, and no general feed supplement reliably prevents the condition.
Will the Mare Be Okay?
Most mares recover well when the retained membranes are recognised and managed promptly.
The prognosis is generally good when:
-
Treatment begins early
-
The complete placenta is expelled or removed
-
The mare remains bright
-
Metritis does not develop
-
Endotoxaemia is controlled
-
Laminitis is prevented
-
The uterus involutes normally
The prognosis becomes guarded when:
-
Treatment is delayed
-
Placental fragments remain
-
Toxic metritis develops
-
The mare becomes septic
-
Laminitis occurs
-
Uterine damage or prolapse develops
-
Multiple postpartum complications occur together
Current veterinary guidance indicates that uncomplicated retained fetal membranes do not generally reduce future fertility. Mares recovering from metritis, significant uterine damage or repeated retention need more careful reproductive reassessment. (Merck Veterinary Manual)
Can the Mare Be Bred Again?
Often, yes.
Before the next breeding attempt, your veterinarian may recommend:
-
Reproductive ultrasound
-
Uterine culture and cytology
-
Endometrial biopsy in selected cases
-
Cervical examination after dystocia
-
Review of previous placental pathology
-
A future postpartum prevention plan
A mare with a previous retained placenta has an increased risk of recurrence, so the next foaling should be monitored closely. (Merck Veterinary Manual)
FAQs About Retained Placenta in Horses
How long can a mare retain her placenta?
The placenta is classified as retained once it has not passed by three hours after foaling. Some mares remain outwardly well for longer, but veterinary treatment should not be delayed while waiting to see what happens.
Can I gently pull the placenta out?
No. Owners should not pull on it. A veterinarian may use controlled traction in selected circumstances, but forceful removal can tear the membranes, cause bleeding or injure the uterus.
Can a tiny retained piece still be dangerous?
Yes. Partial retention, especially at the tip of the non-pregnant horn, can lead to metritis, endotoxaemia and laminitis even when most of the placenta has passed.
Should every mare with a retained placenta receive antibiotics?
Not necessarily at the three-hour point if she is bright and treatment begins promptly. Systemic antibiotics become more likely with prolonged retention, contamination, suspected metritis or systemic illness.
How long should the mare’s feet be iced?
There is no fixed universal duration. Continuous cooling is generally continued while the mare remains at meaningful risk of endotoxaemia-associated laminitis, as determined by the veterinarian.
Final Thoughts
A retained placenta is common enough that every foaling plan should account for it, but serious enough that it should never be managed casually.
The essential rules are:
-
Record when the foal is born.
-
Confirm that the complete placenta passes within three hours.
-
Call the veterinarian if it does not.
-
Never pull or attach weights.
-
Preserve the placenta for examination.
-
Monitor the mare for metritis, endotoxaemia and laminitis.
-
Continue monitoring after the membranes pass.
You do not need to panic when the placenta has not passed immediately.
You do need to respect the clock.
Early oxytocin, controlled uterine clearance, appropriate systemic treatment and proactive laminitis prevention can turn a potentially life-threatening complication into a straightforward recovery.
If your mare has not passed the placenta, appears unwell after foaling or you are unsure whether the membranes are complete, ASK A VET™ can help you organise the timeline and warning signs while your local equine veterinarian provides the urgent hands-on treatment she needs.