Navigating Equine Practice through Pregnancy

Here we offer a synopsis of a general survey of (female) equine vets in Aotearoa on the tribulations and joys of pregnancy in relation to working in equine practices throughout the country. This survey was conducted via your NZEVA Executive with particular guidance from Katie Kindleysides and with editorial input from NZVA.

Image courtesy Marieke van den Enden.

Realising you’re pregnant can be an exciting yet daunting time for all. Alongside accommodating usual pregnancy concerns, equine vets and nurses must consider what changes are needed to minimise the additional risks our work brings to ourselves and our unborn children. Here we hope to address a few of the common concerns, using examples from previously pregnant, Kiwi equine vet mums and giving links to helpful advice.

EARLY DAYS – START SPREADING THE NEWS!

The legal requirements on when to inform employers of your pregnancy are related to parental leave and readers are referred to the Department of Employment website (https:// www.employment.govt.nz/leave-and-holidays/parental-leave/ how-to-apply-for-parental-leave/). However, Health & Safety policies usually require clinical veterinary employees to inform their employer of a pregnancy as soon they are aware. Regardless, ‘the sooner they know, the sooner you can be kept safe’ (Crowe, 2014). This can be a positive discussion that helps alleviate some early anxiety around risks at work, despite negative fears you may have. Previously pregnant vets share their thoughts and experiences of early discussions with employers [Text Box 1].

Text Box 1: ‘Early in my first pregnancy I received a kick to the abdomen on farm. I hadn’t told anyone I was pregnant, so I didn’t feel I could talk about it then, either. Luckily it was so early my pregnancy was well protected, but I could have avoided the stress if I’d let my employer know.’ ‘I was also offered a new job when I was openly trying to get pregnant/early pregnancy which was amazing to me at the time and will always be grateful for……. I can see it from both sides as pregnancy is a huge inconvenience for a practice especially if your job involves a lot of x-raying etc. From my experiences though I think having open conversations about this at the time of employment is the better way to go, however it does leave females more open to be discriminated against, no easy answer.’ ‘When I told my employer about my pregnancy, they immediately made plans for me to avoid x-rays and anaesthesia and the team was incredibly supportive. They looked out for mine and my baby’s safety better than I did!’ ‘When pregnant in practice with my first, the support and enthusiasm for starting a family from my bosses was lovely. On a day-to-day basis it sadly was not matched by a concern about how I was coping with working whilst pregnant. My advice to others would be to communicate clearly with your employers, know the legal info around pregnancy, take a support person to meetings and take notes of what is said.’

KEEPING YOU AND BABY SAFE

Many risks can be mitigated by delegation to or assistance by colleagues or nurses/technicians [Figure 1]. This time can be

Figure 1: With the use of adequate restraint, such as a suitable crush, and the availability of extra handlers, pregnant veterinarians can reduce the risks of physical injury due to trauma. (Photo courtesy of Pip Hendron)

Text Box 2: ‘Each time I've been pregnant I have happened to have had a new grad or young vet who does all the bits I can't do. Feedback from these vets on this has been good as they get collegial support but hands on experience and responsibility on trickier cases whilst the preggo vet is in the background giving advice, critiquing X-rays and scans where needed. Plus, the younger vet can get a good rapport with the client and massively improve on their clinical skills.’

a great opportunity to mentor students or recent graduates, as one vet found during her pregnancies, which then helped the team during her parental leave period [Text Box 2]. Worksafe (2017) advises employees have the right to refuse to work in situations which are hazardous or unhealthy, and in such circumstances they must inform the health and safety officer. Despite this, the below stories indicate pregnant equine vets can feel pressured to put themselves in situations they consider unsafe [Text Box 3]. Given the variation between individuals, it may not be clear to others which calls are suitable to attend as pregnancy progresses (Dickinson, 2016). Regular opportunities to discuss with management which procedures and jobs are not suitable for the pregnant practitioner (or require extra assistance) need to be made and outcomes shared with everyone in the equine team (especially those booking calls). A mentoring system as discussed by one previously pregnant vet can be useful to build trust for a truly honest conversation [Text Box 4]. Below is a non-exhaustive list of aspects of equine practice posing specific health and safety risk during pregnancy. Risks for each area are identified but specific recommendations have been purposely avoided as individual needs will vary. Where relevant, quotes have been included from previously pregnant working vets to give examples of how they mitigated risk or what they feel could have been done differently during their own pregnancies. Pregnant individuals should discuss risks of their clinical duties with their midwife/obstetrician as well as their employer/team when considering a personal Health & Safety plan.

Text Box 3: ‘My boss was really understanding and accommodating of changes I needed, but I felt pressured to attend calls I wasn’t comfortable with when they were booked where there was limited ability to reschedule with someone else.’ ‘I had no mentor, no one to check in with, no health and safety advice from work, my midwife, or GP. All that fell to me to manage my calls, equipment/help from colleagues, and I felt a huge sense of responsibility to keep doing everything I could’ ‘I felt like I was burdening others if I couldn’t do something, and still the drive to prove girls can do anything in a male dominated (stud work) industry remained, but that’s my fault! All in all, I was treated very fairly while pregnant and did not have pressure put on to do anything unsafe’

RISKS

Exposure to exogenous hormones

During pregnancy accidental exposure to hormone products, in particular exogenous prostaglandin, may lead to complications such as miscarriage or premature labour (Scheftel et al., 2017). Many pregnant vets will continue to handle and administer these medications during pregnancy using gloves, but examples of needle stick injuries causing harm to pregnancy (Morris, 2000) remind us that extreme caution is needed. Although primarily used for treatment of gastrointestinal pathology, equine practitioners are reminded that misoprostal is a potent prostaglandin used heavily in human medicine for pregnancy management and is readily

Text Box 4: ‘Where I am we have a mentoring program with regular vet-to-vet coffee catch ups in work time. This is where all vets can have informative catchups with chosen mentors or just other colleagues to make sure they are happy how they are going. It's really nice for the younger vets too.’

absorbed across mucus membranes as well as via the gastrointestinal tract (Tang et al., 2007).

Exposure to harmful medications

General information on many medications and their safety in pregnancy can be found on the BUMPS website (https:// www.medicinesinpregnancy.org/Medicine--pregnancy/). The information is aimed at those taking medications during pregnancy, but it is useful to help identify which compounds may be harmful to a pregnancy with accidental uptake. Cytotoxic medications (including topical sarcoid therapies) carry significant potential harm to unborn children, who can be exposed via absorption by their mother. Home | WorkSafe New Zealand (2020) advises that pregnant workers are to be informed of the risks and offered alternative duties. Although beyond the scope of this article, there is concern cytotoxic agents can be transferred to infants via breastmilk (Albin, 2010) therefore caution around their use may remain upon return to clinical duties.

Inhalation anaesthesia

A successfully leak-tested circuit with active scavenging is considered very low risk for any personnel in theatre, but inhalation of unscavenged anaesthetic vapour is a significant risk to a pregnancy (Shirangi et al., 2009). The highest risk during equine anaesthesia is during connection and disconnection of the endotracheal (ET) tube to the circuit, as well as potentially during set-up, dismantling, and cleaning of the anaesthetic unit. Horses will also continue to exhale anaesthetic gases for a period post-surgery, especially where no washout period has occurred prior to the end of surgery. Considering comments made below regarding physical injury, there is a significant risk to especially heavily pregnant personnel involved in any anaesthetic induction or recovery (including for in-field procedure) due to working closely with ataxic/falling horses.

Exposure to ionizing radiation

The maximum level of ionizing radiation for operators (set within the Radiation Safety Act 2016) is lowered to 1mSv annually for pregnant workers (Ministry of Health, 2022). Although the risks of high exposure are very low with safe radiographic technique, as it is usually an elective procedure that can be delegated, and dosimeter readings only give information after the event of high exposure, many feel it is safest for pregnant veterinarians and nurses/technicians to avoid radiography and scintigraphy all together. If clinical veterinary workers choose to remain working with radiography, stringent following of safety procedures is required, including keeping as far away from the primary beam as possible (i.e. no direct plate or generator holding). Where relevant, risks of scintigraphy are also to be assessed for pregnancy and the risk of handling of radionucleotides needs to be extended to those who are breastfeeding. The UK’s Health and Safety Executive (HSE) has provided a useful guide on operator safety for use of ionizing radiation during pregnancy and breastfeeding, which is available at https://www.hse.gov.uk/pubns/indg334.pdf. The reader is advised to consider differences between UK and NZ legislation when consulting this document.

Heavy lifting & physical exertion

Individual lifting ability throughout each stage of pregnancy is variable and overloading can risk adverse pregnancy events

Figure 2: Being able to sit comfortably for long procedures can help to reduce the risks of prolonged standing and prevent crouching, which can be more challenging during pregnancy. (Photo courtesy of Marieke van den Enden).

Text Box 5: ‘It is a difficult one and I took risks I shouldn’t have when pregnant, but it was my choice, and I was always supported by my employers to not to in terms of [avoiding] physical risks. I have had more close calls and near misses when not pregnant just due to the nature of the job and years I’ve been doing it. I worry more about something happening to me now that I have kids that need and depend on me than I did when pregnant (rightly or wrongly).’ ‘I got kicked in the chest scanning a mare when I was pregnant. I think at that time (over 13 years ago) I was probably in the mindset of having to prove I could still be of use as a pregnant woman because there was quite an undercurrent of it being substandard. I didn’t want to let anyone down I guess.’ ‘I remember a colleague telling me bending down for distal limb exams was one of the hardest things to continue doing as pregnancy progresses. I stopped doing foot exams during second trimester during one pregnancy as it was too uncomfortable but continued into third trimester the next time.’ ‘I finished doing clinical duties at 34 weeks, on my final day I had a mini dental booked - thankfully it was the best mini mouth I’d ever seen and hardly needed any work as crouching that low was becoming almost impossible.’

(MacDonald et al, 2013). When making decisions on the physical limits of a pregnant veterinary worker it’s noted that estimations of loads lifted when working with animals are difficult to predict (Scheftel et al., 2017), and only a pregnant individual can identify what amount of physical loading on their body feels safe for them at any given point. Current recommendations for physical exercise (including weights lifted) are focused on your fitness level prior to pregnancy rather than arbitrary limits and RANZCOG (2020) have produced a helpful fact sheet on this, which is available HERE. This guide also identifies how to spot harmful levels of exertion during pregnancy. In addition, pelvic floor physiotherapists (name withheld, 2022) advise pain, any leakage of urine, or a heavy/dragging feeling in the vagina during strenuous activity indicates overloading and a need to adapt. Related to injuries from overloading, relaxin hormone release in pregnancy starts in the first trimester and rises throughout pregnancy to increase joint laxity (Healthline.com, 2020). Along with a changing centre of balance, all of this equates to an increased risk of injury from physical exercise/ work during pregnancy, alongside the risks of pregnancy related pelvic injury, such as prolapse.

Reduced mobility & exposure of the pregnant abdomen to trauma

Horses are no more likely to kick, rear, or rush forward when those around them are pregnant, but pregnancy leaves the body more exposed, and the consequences of injuries are higher. Before 12 weeks gestation the pregnant uterus is well protected within the pelvis but becomes more exposed throughout the second trimester and the resultant expansion of the abdomen becomes physically restrictive, particularly into the third trimester. This alongside the changing centre of gravity, which may affect balance, contributes to a lowered ability to move quickly and safely out of the way, particularly when bent/crouched down. Previously pregnant vets shared several experiences and thoughts on how pregnancy affects the risks of equine work [Text Box 5 and Figures 2 & 3].

Extended work hours and night shifts

Tiredness and exhaustion can be regular concerns of those in equine veterinary roles, but pregnancy contributes to this with generalized exhaustion and potential sleep disturbance. Prolonged standing and shift/night work has been associated with negative outcomes in pregnancy (Mozurkewich et al., 2000) and the long hours of vet work specifically have been found to increased risk of adverse outcomes of pregnancy (Shirangi et al., 2009). Regardless of physical ability and safety concerns, exhaustion alone may be the driver of a change in after-hours duties and work hours as well as an increase in sit-down breaks. Vets sharing their personal experiences discussed needing to reduce hours as a consequence [Text Box 6].

LOOKING AFTER YOURSELF

Keep moving

Being on your feet too long is unhealthy in pregnancy, but so is being overly sedentary (RANZCOG, 2020). In practice this is unlikely to be a concern but needs consideration if you temporarily move to an administrative role. For ambulatory vets, long frequent car journeys can be problematic. Keep cool & hydrated (and make space for pit stops!) It’s common knowledge that pregnant women feel the heat more and related to this is an increased risk of dehydration that can present risks to your pregnancy’s health (Tommy’s, 2022). The need to keep hydrated only adds to the expected increased frequency of urination so be prepared to build regular bathroom breaks into your day. Heat exhaustion is most of concern to those doing physical outside calls during summer [Text Box 7].

Morning sickness

Morning sickness or hyperemesis gravidarum is hugely variable both between women and between repeat pregnancies. In severe cases it is rather devastating as

Figure 3: Back and belly support such as the SmileybeltTM seen here can be useful to reduce some pregnancy-related discomfort when working in a physical role. (Photo courtesy of Pip Hendron).

Text Box 6: ‘Working part-time throughout pregnancy meant I could cope with the long days on my feet better as when I wasn’t in work I could take it easy and recoup.’ ‘I was surprised how tired I was and had to take it easier in terms of hours and workload as a result.’

Text Box 7: ‘‘Working an ambulatory role during summer was hardest during the first trimester as I was still doing as much as pre pregnancy, I was exhausted and dehydrated really quickly, and owners didn’t expect it as they didn’t know I was pregnant. We had to put limits on things like how many dentals I could do at each call.’

Text Box 8: ‘I struggled to keep water down without vomiting for the first trimester so was hospitalised on fluids and was so sick I couldn’t work at all for the 1st 3 months before I had a big belly. So, I had to take 3 months of my maternity leave before I even looked pregnant! This was a total shock to me as I was super fit and doing long distance running before I got pregnant. I presumed I’d just cruise through pregnancy and keep working till I dropped, but no such luck! I had to take dry rice crackers with me to nibble on all day in the car and at the clinic, when I did get back to work later in my pregnancy, to stave of the nausea! Not everyone feels sick, and I was always so envious of those who could eat normally and enjoyed being pregnant! My 2nd pregnancy was worse that the 1st with extreme nausea. My girls always say they nearly killed me before they popped out to say hello!’

Text Box 9: ‘One of the cool things is how women [in practice] actually support each other and pick up the slack when someone else has stuff going on. Also, so many guys have young kids, so they really understand.’

attested to by one colleague [Text Box 8] and may well have been the demise of Charlotte Bronte.

Mental health

12% pregnant women have a high level of depression (this doesn’t include those with anxiety or mild levels of depression). It’s acknowledged 50% women who suffer depression in pregnancy will suffer from post-natal depression. In addition, 1 in 50 men have been found to have symptoms of depression prior to the birth of their child, 4.3% of fathers are known to suffer from depression in the post-natal period (PADA, 2017). In an industry where mental health concerns are already high throughout; it seems

pertinent to remind us all to be aware of the signs personally and in those around us and be prepared to offer support and direct them to appropriate help. Finally, PADA is a site focused on ante- and post-natal mental health where further information can be found for expectant and current parents [Text Box 9]. Below equine vets have given some great insight into when they stepped back during their pregnancies alongside what allowed them to keep going and what indicated a change was needed. Although examples from the likes of peers can be helpful guides to plan when to step back from various clinical duties, as shown below, each pregnancy can be very different and listening to your body is vital [Text Box 10].

REMAINING A PRODUCTIVE TEAM-MEMBER DESPITE REDUCED CLINICAL DUTIES

As a pregnant veterinarian you may hit a point where even a clinical examination doesn’t feel comfortable, but you may not feel ready to step out the clinical environment all together and wish to still contribute to the team. Below are some ideas on areas clinical where workers can assist as their physical needs required them to step back. They have come from personal experience, experiences of peers, and suggestions from Carolyn Crowe’s BEVA presentation (2014) [Text Box 11].

• Mentoring students and recent graduates

-Allows learning from your experience whilst providing the pregnant individual with an extra pair of hands, especially during higher risk procedures.

• Clinical administrative task

-Is the radiography manual up to date? Do you need to audit some services/prices? Does your newsletter archive need an update? -Whether it’s for compliance, general management, or marketing, all of these activities make good use of a practitioner’s brain and can be financially beneficial to a veterinary practice, but they are often the non-urgent tasks that get side-lined.

• Call triage and client communications.

-Can be useful support for customer service workers especially during vet shortages when scheduling appointments may be trickier. -Can be an opportunity to use an experienced practitioner to train other members of the team on appropriate length of time for appointments determining the priority of a call. -A non-clinical veterinarian can also be used to report the likes of laboratory reports to client where the case vet feels it is appropriate. For some working less hours (as needed) through pregnancy can be the best option to remain active in practice for as long as you wish to. This may involve taking leave or a temporary change in contracted hours depending on how it can be accommodated by your employer.

PLANNING FOR YOUR LEAVE

Whether leave starts as you’d plan or is brought forward unexpectedly, walking away from vet practice for a prolonged period is often unknown territory. For some, it’s so full of new challenges and social interactions that little thought is given to our careers, but for others it’s monotonous, isolating and

Text Box 10: ‘I did repro work until 2 weeks pre-partum, and general first opinion work till 3 days pre-partum - was meant to have 2 weeks off, but baby arrived early.’ ‘I was working until around 7 months gestation. Timing worked out so I was off clinics during first trimester. Then avoided x-raying and physically rough situations. Easier as we had so many students and residents though.’ ‘During both pregnancies I noticed a change in my physical ability and energy levels around 32 weeks that initiated conversations about taking a step back. Until then I’d felt fine with long workdays but suddenly everything was harder and more uncomfortable.’ ‘Employers and clients were great, looked out for me, were cautious about what they asked me to do. I was probably happier carrying on than I needed to be, but I was only small and still felt comfortable and stable in most situations. I stopped doing yearling work, wrestling foals, and dealing with limbs/flexions etc. by about 6 months, and was very fussy about the people I had holding and handling horses for me.’ ‘My final after hours weekend (at 28weeks) involved treating a stallion and I was really grateful a colleague was available to take on the care as I just didn’t feel safe even injecting him.’ ‘It was easier when pregnant with my second child as I took the role during the first trimester with everyone being aware. I was an extra person so although I still felt guilty for not being able to contribute as much as I could have, it wasn’t as hard as taking a step back in a busy team and watching my workload get added to a colleague's day list. Ultimately in an industry that tends to have overworked employers working within a close team, it's hard to feel OK about putting yourself first to take a step back whether it’s for pregnancy, injury, or mental health - it’s something we all need to get better at doing and accepting of in our peers.’

there’s a wish to be back using their vet brain. Often it differs from our expectations. Prior to heading on leave there is value discussing with your employer whether you wish to have contact and at what level throughout your leave, including how to manage clients that contact you directly. Would you still

like to attend clinical discussion or be available to assist for certain procedures? Would you like to receive practice emails or prefer to not be contacted? Just as for pre-birth plans, accept thoughts on this may change and regularly review if your original decisions are still right for you. Below are two differing experiences of work contact during parental leave [Text Box 12]. For employed workers on paid parental leave there is the option to discuss use of ‘Keep in Touch (KIT) days’ with your employer, details are available at https://www.employment. govt.nz/leave-and-holidays/parental-leave/types-of-parentalleave/keeping-in-touch-days-2/. These can be useful to keep you involved with the team whilst you are away from clinical duties and help you gauge if you’re ready to return to work earlier than originally planned.

Text Box 11: ‘Later in pregnancy when I stepped back from clinical duties on my own request, I could still be involved in cases by working closely with reception to triage and provide veterinary advice to clients alongside reporting clinical progress and lab results to clients for general matters. I was also able to act as a sounding board to the new grad.’ ‘I was fortunate to be working part-time throughout pregnancy, having a break midweek really helped me cope with the long days and I had to plan at least one of my non-workdays each week to do nothing but rest.’

Text Box 12: ‘Once I was on leave it was as if I’d left. I was grateful there was no pressure for back to work discussions, but I also felt isolated from the team and lost my feeling of purpose within it.’ ‘When I went on maternity Ieave, I and my mentee would stay in touch if they ever had something they wanted to discuss (which I found nice as I felt needed and useful as a horse vet not just as a mum).’

INFERTILITY AND LOSS

It feels incomplete to not touch on the difficulties so many sadly face when hoping to start or expand a family. It’s estimated over a quarter of New Zealanders will face infertility as some point (Fertility NZ, 2022) and at least 1-2 of every 10 pregnancies end in loss (Ministry of Health, 2022). Often these heart-breaking situations occur before many are aware a couple is trying to get pregnant. This can result in the devastation being compounded by the feeling that their tragic experiences can’t be shared, and many would-be parents continue to work as they face the physical and emotional pains. We work in client facing roles among a workforce strong in those of childbearing age; such personal grief can be very difficult to manage when others’ obvious pregnancy journeys are visible around us and clinical situations can be triggering where they echo personal difficulties. When those walking infertility or loss journeys experience pregnancy, many of the risks we face working in the veterinary industry can drive additional anxiety, so a more cautious approach may be taken. This isn’t always understood by management or colleagues who may not be aware of the story. In Text Box 13 are some experiences of such losses from equine practitioners: Fertility New Zealand (https://www.fertilitynz.org.nz/) offer

Text Box 13: ‘When I had my miscarriage no one apart from some of the directors knew, it was devastating’ ‘I had 3 miscarriages before 12 weeks that my employers all new about, in a normal job they would have been none the wiser.’ ‘I delivered a stillborn baby during second trimester after an unexpected complication. Clients had only just started to be aware of my pregnancy. Returning to work I didn’t know who knew and who didn’t so it was really important to me to have everyone made aware of the loss to avoid someone putting their foot in it. Even though the complication wasn’t work related, I was much more anxious during the next pregnancy and found everyone’s excitement for me difficult.’

information and support to those affected by infertility. SANDS New Zealand is a charity focused on supporting bereaved parents through miscarriage, baby loss, and infant death. Readers are also reminded that you now have a legal right to use bereavement leave for a loss at any point in pregnancy (Employment New Zealand, 2021).

SUMMARY

Pregnancy is an individual journey that can bring up the unexpected, be prepared that what you envisaged yourself doing and what you’ve witnessed others do may not end up being what you do. Plan for frequent communication with your employer and understand they cannot know how you are doing without open and honest discussion. In return employers must also be accepting that their previous experiences of pregnancies are a guide not a precedent. Where challenges rise all must be prepared to look for solutions and understand some compromises may be needed to accommodate specific requests but ultimately, it’s about keeping everyone safe.

ACKNOWLEDGEMENTS

With many thanks to the equine vet mums of Aotearoa NZ who kindly took time to openly share their tribulations and joys of pregnancy to make this article possible, the power of your stories is a gift to our future vet parents.

REFERENCES

Albin, K. (2010). Administering Chemotherapy: is it safe for pregnant or breast-feeding veterinary technicians. Vet Tech October 2010 (E1-E5)

Crowe, C. (2014). Equine Practice and Pregnancy. [Online Lecture] BEVA, April. Available at: https://cpd. ebeva.org/course/view.php?id=168 (Accessed: 20th Sept 2022).

Dickinson, A. (2016). Pregnancy in Practice. VetScript, 29(4), pp.54-57.

Employment New Zealand (2021) Bereavement Leave to Cover Miscarriage/Stillbirth [Online] Available at:https://www.employment.govt.nz/about/news-andupdates/bereavement-leave-to-cover-miscarriagestillbirth/#:~:text=The%20law%20change%20allows%20 an,ends%20by%20miscarriage%20or%20stillbirth (Accessed 19th October 2022).

Fertility NZ (2022). Trouble Conceiving [Online]. Available at: https://www.fertilitynz.org.nz/information/troubleconceiving/ (Accessed 15th October 2022).

Health & Safety at Work Act 2015. Available at: http:// www.legislation.govt.nz/act/public/2015/0070/latest/ DLM5976660.html (Accessed: 15th October 2022).

MacDonald, L.A., Waters, T.R., Napolitano, P.G. et al. (2013). Clinical guidelines for occupational lifting in pregnancy: evidence summary and provisional recommendations. Am J Obstet Gynecol, 209(2), pp.80-88.

Ministry of Health (2022) Miscarriage and Stillbirth [Online]. Available at: https://www.health.govt.nz/yourhealth/pregnancy-and-kids/services-and-support-duringpregnancy/miscarriage-and-stillbirth (Accessed 15th October 2022).

Morris, S. (2000) Health and Safety in Practice. In: Proceedings of the annual seminar of NZ Veterinary Nurse Association: NZVA Conference, 8-11th June 2000, Auckland, NZ. Pp.85-94.

Mozurkewich, E.L., Luke, B., Avni, M. and Wolf, F.M. (2000). Working conditions and adverse pregnancy outcome: a meta-analysis. Obstet Gynecol, 95(4), pp.623635.

RANZCOG (2020). Exercise during Pregnancy. Available at: https://ranzcog.edu.au/wp-content/uploads/2022/05/ Exercise-during-pregnancy.pdf [Accessed 5th October 2022].

Scheftel, J.M., Elchos, B.L., Rubin, C.S. and Decker, J.A. (2017). Review of hazards to female reproductive health in veterinary practice. J Am Vet Med Assoc, 250(8), pp.862872.

Shirangi, A., Fritschi, L. and Holman, C.D.A.J. (2009). Associations of unscavenged anesthetic gases and long working hours with preterm delivery in female veterinarians’. Obstet Gynecol,113(5), pp.1008-1017.

Tang, O.S., Gemzell-Danielsson, K. and Ho, P.C. (2007). Misoprostol: pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynecol Obstet, 99, pp.S160-S167.

Tommy’s (2020) How Much Water Should I Drink in Pregnancy [Online], Available at: https://www.tommys.org/ pregnancy-information/im-pregnant/nutrition-in-pregnancy/ how-much-water-should-i-drink-pregnancy (Accessed 15th October 2022).

Worksafe (2017). Your Rights and Obligations. Available at: https://worksafe.govt.nz/managing-health-and-safety/ workers/your-rights-and-obligations/ (Accessed: 15th October 2022).

Worksafe (2020). Cytotoxic Drugs: Good Practice Guide. Available at: https://www.worksafe.govt.nz/ topic-and-industry/health-and-safety-in-healthcare/ cytotoxic-drugs/#:~:text=Exposure%20to%20cytotoxic%20 drugs%20can,related%20waste%2C%20are%20at%20risk (Accessed: 5th October 2022).

FREE ACCESS TO EQUINE VETERINARY EDUCATION PODCASTS

Listen on your phone with the Podbean Podcast App & Player

Listen to these audio PodCasts that are discussions with the authors of selected EVE papers on topics including: Small intestinal intussusception Hydroxyethyl starch solutions in fluid therapy Sand enteropathy Distal limb cellulitis Renal disease Responsible antimicrobial use Difficult Horses Tracheal Perforations Cannabinoids White line disease Hindlimb proximal suspensory desmopathy Stifle radiography Normal radiographical variants Cutaneous squamous cell carcinoma Multimodal strategies for equine analgesia Electroacupuncture Equine odontoclastic tooth resorption Atypical myopathy Equine rhabdomyolysis syndrome Large colonic impactions

Whisenant KD et al. Prognosis for survival to discharge and racing performance in Thoroughbred foals treated for single joint septic arthritis (2009-2016). Eq Vet J 2022 Oct: DOI 10.1111/evj.13892

Data were collected from one large KY equine hospital records for 95 cases of TB foals 6 months of age or less suffering from a single septic joint of presumed haematogenous origin without recognised systemic sepsis or other serious comorbidity, compared with a group of maternal sibling control foals. Overall, the prognosis for survival was high (93%). The last measured synovial cell count prior to hospital discharge or euthanasia (OR 0.5, p = 0.002, 95% CI: 0.3-0.8) was an indicator of poor prognosis for survival to discharge. Total winnings per career were the only statistically significant racing performance variable between cases and paired controls (IRR 0.7, p = 0.05, 95% CI: 0.5-0.99). Thus, while total winnings were reduced compared with maternal siblings, these TB foals with single joint septic arthritis had a favourable prognosis for survival and for starting in a race.

NOTE: There were many limitations to this retrospective study including great variation in prior therapy, specific joint involved, antimicrobial selection, varied absence of full clinical data, and use or not of a surgical procedure. The data also informs that 62 of the 95 affected foals (65%) subsequently raced, whereas 147 of 190 maternal sibling, matched control foals (77%) subsequently raced.