CHAPTER 20
Cervical Tears
ROLF M. EMBERTSON
CORTNEY E. HENDERSON
C
ervical lacerations or tears, which often form
defects when healed, have long been recognized as
a cause of mare infertility. The cervix can function
as a physical barrier, separating the uterus from the
vagina. During pregnancy and diestrus, when under the
influence of progesterone, this muscular tube is tightly
closed. This barrier protects the uterus from infectious
agents and debris that may have gained access to the
cranial vagina. Depending on size, a defect in the cervix
may adversely affect cervical function and thus the ability
of the mare to conceive and carry a foal to term. It is
important for fertility that cervical defects be promptly
recognized and managed appropriately.
ANATOMIC FEATURES OF THE
EQUINE CERVIX
The cervix of a nongravid mare in diestrus typically is a
strong and resilient tubular smooth muscle sphincter
measuring 2.5 to 5.0 cm in diameter and 5.0 to 7.5 cm in
length.1 The muscular cervix is an extension of the
uterine body, with the distal portion protruding caudally
into the anterior vagina and containing the external cer-
vical os. The endometrial folds of the uterine body con-
tinue longitudinally along the length of the cervical canal
and create the folded mucosal surface of the cervical
lumen. The cervical epithelium is made up of ciliated
epithelial and mucus-producing cells.2 The vascular and
nerve supply to the cervix comes primarily from the
vaginal artery, vein, and nerve. The vaginal artery arises
from the internal pudendal artery, branching from the
internal iliac artery, which is a terminal branch of the
abdominal aorta.3
ETIOLOGY OF CERVICAL LACERATIONS
An important characteristic of the equine cervix is the
inherent elasticity of the cervical tissue. This elasticity
allows the cervical walls to expand greatly for passage of
the fetus during parturition. Cervical lacerations occur
most commonly from excessive and/or abrupt cervical
stretching during foaling. This is especially true if
the cervix has not relaxed sufficiently. Cervical tears
are more likely to occur during dystocia than during
normal parturition. Nevertheless, a cervical tear can
occur during unassisted, normal foaling. In fact, one
study showed that 86% of the mares presented for
cervical defect repair sustained the injury after an
apparently normal foaling.4 Manipulations performed to
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deliver a fetus vaginally from a mare in dystocia, are
sometimes done with swollen tissues and inadequate
lubrication.5,6 This places the cervix at increased risk for
injury. A fetotomy also increases the risk for cervical
trauma.
Other causes of cervical defects are rare. Cervical lac-
eration in an Arabian mare as a result of cervical pene-
tration by the stallion’s penis during breeding has been
reported.7 Cervical incompetency due to congenital
failure of cervical closure has been reported in a 2-year-
old filly.8
No site around the circumference of the cervix has
been reported to be predisposed to tearing.9 This finding
is supported by our clinical experience. Presentation for
cervical defect repair in the thoroughbred is most com-
monly done in the middle-aged, multiparous mare.4
DIAGNOSTICS
The most common problems associated with cervical
defects are endometritis and infertility. Failure to con-
ceive and early term abortion are problems more com-
monly seen with large cervical defects. Late-gestation
abortion is more commonly seen with medium size
defects.
Careful examination of the cervix is an important part
of the reproductive examination of the mare. A vaginal
speculum is routinely used in evaluation of the cervix.
Cervical defects can be overlooked, however, on the basis
of visual inspection alone. This is especially true during
the estrous period, when visualization of the defect may
be obstructed because of the presence of tissue edema.
Edematous cervical folds may overlap and obscure the
laceration site from view.7 The cervix ideally is examined
with the mare in diestrus. The cervix exhibits minimal
edema and is contracted and tight, allowing accurate
evaluation of the competency of the cervical wall. Digital
palpation is necessary for full appreciation of a cervical
defect.
Recording or describing the site of a cervical abnor-
mality is simplified by considering the external margin
of the cervix as analogous to the face of a circular clock
(Fig. 20-1). The most dorsal aspect of the cervix corre-
sponds to the 12 o’clock position, whereas the ventral-
most aspect corresponds to the 6 o’clock position.
Palpation of the cervix is done using a sterile glove or
sleeve and an ample amount of sterile lubricant. The cer-
vical wall is evaluated between the operator’s thumb and
index finger, with either the thumb or finger inserted into