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Topic:Pregnancy

Pregnancy in horses, or equine gestation, is a physiological process that involves the development of a foal within the mare over approximately 11 months. This period is characterized by distinct stages, including fertilization, embryonic development, and fetal growth. Throughout gestation, mares undergo various physiological and hormonal changes to support the developing fetus. Monitoring pregnancy in horses involves assessing fetal health and mare well-being through veterinary examinations and diagnostic tools such as ultrasound. This page compiles peer-reviewed research studies and scholarly articles that explore the physiological processes, management practices, and health considerations associated with equine pregnancy.
Cryptophthalmia, microphthalmia, oronasal malformation, and hydrocephalus in an aborted equine fetus with umbilical torsion in the state of Mato Grosso, Brazil.
Veterinary research communications    February 28, 2026   Volume 50, Issue 3 178 doi: 10.1007/s11259-025-11060-9
Barrantes Murillo DF, Camillo G, Souza Serrano B, Almeida Luciano LP, Castilho Bichara GV, Chaves Vás CA, Furlan Gouvêa FH, Brandini Nespoli PE....Facial abnormalities and brain defects in aborted equine fetuses are rarely reported, and the causes that predispose the occurrence of this condition are difficult to identify. This work reports the morphological and tomographic findings of a case of cryptophthalmia, microphthalmia, oronasal malformation, and hydrocephalus in an aborted equine fetus with umbilical cord torsion in the state of Mato Grosso, Brazil, from a primiparous Quarter Horse female, with 7 months of gestational age. The occurrence of miscarriage was associated with compromised maternal-fetal blood flow due to umbilical cor...
Effects of rectal examination on intraocular pressure and behavioral responses in pregnant and non-pregnant mares.
Journal of equine veterinary science    February 24, 2026   Volume 160 105821 doi: 10.1016/j.jevs.2026.105821
Çortu A, Çınar H.Rectal examination is routine in equine reproduction but may trigger acute stress affecting welfare and safety. Intraocular pressure (IOP) responds rapidly to autonomic changes and may capture short-lived stress responses. Objective: To evaluate whether rectal examination acutely affects IOP and behavioral responses in mares, and whether reactions differ by reproductive status. Methods: Twenty Rahvan mares (10 pregnant, 30-40 days' gestation; 10 non-pregnant; 4-7 years) underwent transrectal examination without sedation. IOP was measured bilaterally at six time points: 2 min pre-exam (T1), dur...
Single-cell atlas of the equine placenta reveals cellular heterogeneity and gestational-stage-associated programs.
Placenta    February 7, 2026   Volume 176 13-21 doi: 10.1016/j.placenta.2026.02.004
Verstraete MH, Norris JK, Loux SC, De Spiegelaere W, Carossino M, Daels P, Dini P.The placenta mediates critical interactions between mother and offspring that guide development and impact long-term health. Despite its importance, the cellular organization of the equine (Equus caballus) placenta remains poorly defined. The equine epitheliochorial placenta, characterized by the absence of trophoblast invasion and prominent endocrine activity, provides a unique comparative model for studying placental cellular composition and development. Methods: We applied single-cell RNA sequencing to chorioallantois tissue collected from first-trimester (n = 1) and term (n = 2) equine...
Amniotic Mesenchymal Stromal/Stem Cell-Derived Extracellular Vesicles for Equine Chronic Degenerative Endometritis Treatment.
Veterinary medicine and science    February 5, 2026   Volume 12, Issue 2 e70685 doi: 10.1002/vms3.70685
Equine chronic degenerative endometritis (CDE) is a progressive process characterized by endometrial fibrosis that could be responsible for alterations of uterine environment and foetal-maternal communication. Objective: The aim of this study was to try to restore this communication by intrauterine administrations of amniotic cell-derived extracellular vesicles (AMC-EVs) in a case series. Methods: Twelve mares were selected on the basis of their reproductive history of early embryonic loss or abortion and clinical suspicion of CDE subsequently verified with histopathological examination of end...
Activation of the S100A8/A9 Alarmin Amplifies Inflammatory Pathways in Equine Ascending Placentitis.
International journal of molecular sciences    February 4, 2026   Volume 27, Issue 3 1550 doi: 10.3390/ijms27031550
Scoggin KE, Rakha SI, Abdellatif AM, Adlan F, Helmy YA, Ruby R, Ball B, Boakari Y, Ali HE.Ascending placentitis is a significant cause of equine pregnancy loss, yet the upstream inflammatory triggers are poorly defined. Recently, we identified S100A8/S100A9 (S100A8/A9) alarmins as potential upstream regulators in a chronic equine placentitis model. The current study aimed to determine whether this upregulation is sustained in the acute model and in clinical cases, and to elucidate the expression of their downstream inflammatory mediators. Using an experimental model, we quantified mRNA expression in acute ( = 5) and chronic ( = 6) placentitis induced by ssp. . We found mRNA expre...
Effective methods of horse reproduction in the production of mare’s milk.
Brazilian journal of biology = Revista brasleira de biologia    January 30, 2026   Volume 85 e300038 doi: 10.1590/1519-6984.300038
The research aims to study the dynamics of reproductive system pathologies in mares of Kazakh and Mugalzhar horse breeds and their impact on the reproductive traits of the breeding stock. The object of the research was horses of the Kazakh and Mugalzhar breeds. The formation of experimental groups was carried out using the pair-analog method. It was found that the frequency of detection of infertile mares is 13.8-25.0%. Subinvolution of the uterus from the total number of infertile mares is 8.3-10.7%, endometritis - 16.6-23.3%, atony and hypotonia of the uterus - 8.3-13.3%, ovarian diseases - ...
GnRH Administration Increases Synchronisation of Ovulation in Mares.
Reproduction in domestic animals = Zuchthygiene    January 20, 2026   Volume 61, Issue 1 e70165 doi: 10.1111/rda.70165
Cui B, Liu Y, Wu X, Li X.The objective of this study was to evaluate the effects of exogenous GnRH administration at the beginning of estrus synchronisation in mares during the spring transitional period. Estrus was synchronised using a progesterone releasing intravaginal device (PRID). The PRID was left in the vagina for 10 days, followed by an injection of 0.4 mg of cloprostenol at PRID removal. The GnRH group (n = 32) was subjected to intramuscular administration of 100 μg of the GnRH agonist triptorelin at PRID insertion, while the control group (n = 32) received 1 mL of sterile physiological sali...
Investigation of gene stability in equine luteal tissue during mid-diestrus phase and early pregnancy – Research Article.
BMC veterinary research    January 9, 2026   Volume 22, Issue 1 84 doi: 10.1186/s12917-025-05241-6
Ramsaran LN, Byron M, Parry S, Lection J, Back B, Grenier J, Cheong SH, Diel de Amorim M.Real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR) is a technique that allows for the semi-quantification of mRNA transcripts present within a tissue of interest. Differences in the relative abundance of mRNA between samples detected by RT-qPCR require normalization with a reference gene or genes whose transcript abundance is stable within the tissue of interest independent of experimental conditions. In the field of equine reproductive studies, ACTB, GAPDH and B2M genes are the most widely used as reference genes for the normalization of RT-qPCR results. However,...
Effects of intrauterine ozone insufflation in eleven subfertile mares: a case series.
Journal of equine veterinary science    January 7, 2026   Volume 157 105778 doi: 10.1016/j.jevs.2026.105778
Moroni R, Fanelli D, Maltinti S, Orefice M, Rota A, Camillo F, Melanie P, Cantile C, Miragliotta V, Pirone A, Lazzarini G, Passamonti F, Marmorini P....Equine persistent breeding-induced endometritis can lead to chronic uterine inflammation and fibrosis, reducing fertility. Intrauterine ozone (O₃) has recently been proposed as a potential treatment for mares unresponsive to conventional therapies. This case series describes O₃ treatment in eleven mares barren for at least one year despite multiple inseminations attempts. During the first oestrous cycle, low-volume uterine lavage and endometrial biopsy were performed, followed by 3 consecutive days of intrauterine O₂-O₃ gas insufflation. In the subsequent cycle, both procedures were re...
Metabolomics of stallion seminal plasma: Identification of potential fertility biomarkers based on differences between high and low pregnancy stallions.
Journal of equine veterinary science    January 6, 2026   Volume 158 105780 doi: 10.1016/j.jevs.2026.105780
Bueno VLC, Bastos HBA, Centeno LAM, Schmitt F, Larentis G, Mattos RC, Fiala-Rechsteiner S.The seminal plasma (SP), a fluid originating from the testes, epididymis, and accessory sex glands, represents 98 % of the volume of stallion ejaculate. Metabolomic analysis enables the identification of final products of metabolic pathways, providing insights into reproductive physiology. Objective: This study aimed to investigate the metabolomic profile of stallion seminal plasma and to investigate metabolic differences between stallions with high and low pregnancy rates, in order to identify potential biomarkers associated with fertility. Methods: Twenty-four Criollo stallions, were sampled...
Equine fetal-sex determination from mid-gestation to term using serum conjugated steroid profiling by liquid chromatography-tandem mass spectrometry.
Animal reproduction science    January 3, 2026   Volume 286 108098 doi: 10.1016/j.anireprosci.2026.108098
Ledeck J, Dubrowski T, Schoumacher M, Peeters S, Le Goff C, Egyptien S, Deleuze S, Cavalier E, Ponthier J.Refined profiling of conjugated estrogens and androgens during equine pregnancy using liquid chromatography-tandem mass spectrometry (LC-MS/MS) could provide accurate fetal-sex determination. Current methods for fetal-sex prediction remain limited by timing, accuracy, and operator expertise. This study investigated sex-specific differences in maternal conjugated steroid profiles to develop a reliable, non-invasive predictive method. Samples were collected from 141 mares of various breeds starting at sixteen weeks of pregnancy. The samples were pooled according to gestational stage, divided int...
Molecular prevalence of equine alphaherpesvirus-1 shedding in healthy broodmares in Ontario. Cooper CJ, Arroyo LG, Hammermueller JD, Botts MM, Pearl DL, Wootton SK, Lillie BN.Equine herpesvirus-1 (EHV-1) is ubiquitous in the horse population, but prevalence estimates have ranged from 3 to 88% depending on the population and method of sampling. No prevalence studies have been carried out in Ontario, Canada. The objective of this study was to measure the prevalence of EHV-1 shedding in healthy broodmares in Ontario. A total of 381 mares from 42 farms in Ontario were sampled, including pregnant and barren broodmares. Samples were collected from the nose, vagina, and blood of each mare up to 6 times from December 2016 through October 2017 using a cross-sectional study ...
Establishing Reference Values for Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Turkmen Horses: Effects of Gender, Age, Pregnancy and Physical Activity.
Veterinary medicine and science    December 29, 2025   Volume 12, Issue 1 e70755 doi: 10.1002/vms3.70755
Eskandari G, Ahmadi Sheikhsarmast S, Ghasemi S, Mohri M.Neutrophil gelatinase-associated lipocalin (NGAL) is a glycoprotein involved in immune responses and inflammation, with established diagnostic utility in acute kidney injury (AKI) and systemic diseases. However, reference values for NGAL in healthy horses, particularly the Turkmen breed, remain poorly defined. Objective: This study aimed to establish reference values for serum NGAL concentrations in healthy Turkmen horses and to evaluate the influence of age, sex, pregnancy status and physical activity on its levels, as well as its correlations with haematological and serum biochemical variabl...
Changes in Uterine Glandular Composition in Kyrgyz Breed Mares According to Pregnancy Status.
Anatomia, histologia, embryologia    December 26, 2025   Volume 55, Issue 1 e70078 doi: 10.1111/ahe.70078
Risvanli A, Salykov R, Timurkaan N, Seker I, Ekinci E.This study was conducted to examine glandular histological changes in the uterus of Kyrgyz breed mares during the first 6 months of pregnancy. The study used 53 Kyrgyz breed mares; 43 of these were at different stages of pregnancy, while 10 were non-pregnant mares. Uterine samples obtained at the slaughterhouse were evaluated histomorphometrically; endometrial thickness, gland density, gland epithelial height and gland diameter were measured. In conclusion, it was concluded that in Kyrgyz mares, endometrial thickness, glandular epithelial height and diameter increased as pregnancy progressed...
Compounded oral doxycycline in late-term pregnant mares: pharmacokinetics, fetoplacental diffusion, and neonatal safety.
Theriogenology    December 13, 2025   Volume 252 117783 doi: 10.1016/j.theriogenology.2025.117783
Dantas FTDR, Canisso IF, Feijó LS, de Vasconcelos PMF, Campos ML, Ulanov AV, Li Z, Pizzi GLBL, Nogueira CEW, Curcio BR.Doxycycline is widely used in equine medicine, yet data on its pharmacokinetics and safety during late gestation are scarce. We investigated the pharmacokinetics, fetoplacental diffusion, and safety of compounded oral doxycycline in late-term pregnant mares. In the first experiment, six mares at 300 days of gestation received a single oral dose (10 mg/kg), and plasma concentrations were measured using LC-MS/MS. Pharmacokinetic analysis using non-compartmental and compartmental models showed rapid absorption, with a mean Cmax of about 6000 ng/mL reached within 0.8 h and a terminal half-life ...
Sequential changes in serum protein profiles in pregnant Spanish purebred mares.
Veterinary research communications    December 8, 2025   Volume 50, Issue 1 65 doi: 10.1007/s11259-025-10972-w
Satué K, Fauci D, Fazio E, Velasco-Martínez MG, Bruschetta G, Medica P.This study investigates sequential changes in serum protein fractions during gestation in 31 pregnant Spanish Purebred mares compared to 15 non-pregnant control. Total serum proteins (TSP) were measured using the Biuret method, while albumin (ALB), total globulins (tGLOB), and their subfractions (α₁, α₂, β₁, β₂, γ-GLOB) were analyzed by agarose gel electrophoresis. Pregnant mares showed significant changes in serum protein profiles throughout gestation. TSP and tGLOB concentrations increased from mid to late pregnancy (months 6-11), while ALB concentrations declined between months...
Impact of exercise frequency, race distance, age, and pregnancy stage on oxidative stress and lipid metabolism in purebred Arabian mares.
Journal of equine veterinary science    December 5, 2025   Volume 156 105751 doi: 10.1016/j.jevs.2025.105751
Aiche S, Chikhaoui M, Smail F, Benamor N, Benia AR.Pregnancy causes increased oxidative stress in mares, possibly harming both the mare and the foal, whereas the effects of different exercise levels on oxidative stress and lipid metabolism during pregnancy remain unclear. Objective: For this reason, the aim of this research was to explore the impacts of different training intensities on oxidative stress and lipid metabolism during pregnancy. Methods: The study comprised 22 clinically normal Purebred Arabian mares from Algeria, which were divided into three groups according to age and exercise frequency. Blood samples were collected during both...
Progestagens Monitoring in 147 Mares in Order to Induce Foaling With Oxytocin.
Veterinary medicine and science    November 27, 2025   Volume 12, Issue 1 e70697 doi: 10.1002/vms3.70697
Tainturier D, Tainturier B, Michaud S, Briand-Amirat L, Topie E, Moreno D.A total of 147 mares of different breeds (110 were sport or race horses, often very valuable) have been monitored over 5 years from 2012 to 2016. When at or near term, the mares were monitored in order to induce foaling, by checking the mammary development by palpation, analysing the colour and consistency of the precolostrum, estimating the calcium and antibodies concentrations in the precolostrum and by measuring the plasmatic progestagens concentration every day at 6 p.m. At the end of gestation, it has been observed that the progestagens rate levelled off (the top concentration varies from...
Rapidly increasing abdominal profile in a multiparous pregnant Quarter Horse mare.
Journal of the American Veterinary Medical Association    November 19, 2025   Volume 264, Issue 3 354-356 doi: 10.2460/javma.25.09.0590
Pasch LR.No abstract available
Beyond nocardioform: Transcriptionally active microbes and host responses in equine mucoid placentitis.
Equine veterinary journal    November 18, 2025   Volume 58, Issue 2 601-618 doi: 10.1111/evj.70112
van Heule M, Verstraete M, Norris JK, Graniczkowsa KB, Scoggin KE, Ali HE, Ball BA, De Spiegelaere W, Daels P, Weimer BC, Dini P.Nocardioform placentitis (NP) is an understudied form of equine placentitis historically attributed to nocardioform bacteria, yet it remains uncertain whether these organisms are the sole pathogens involved. Objective: To elucidate the pathophysiology of NP and the host-pathogen interaction. Methods: In vivo clinical multi-omics study. Methods: Dual RNA sequencing was performed to profile transcriptionally active microbial communities and concurrent placental transcriptome responses in samples from 31 placentas with and without NP. Untargeted metabolomics was performed to study the associated ...
Equine abortion due to Chlamydia psittaci in South Australia with zoonotic transmission.
Australian veterinary journal    November 11, 2025   Volume 103, Issue 12 902-905 doi: 10.1111/avj.70034
McLachlan AD, Woolford L.Chlamydia psittaci was detected by real-time PCR in the lung, liver and kidney of an equine foetus that had aborted in South Australia in August 2023. The corresponding microscopic lesions included lymphocytic and histiocytic chorionitis, necrosis of placental villi associated with bacteria in the cytoplasm of trophoblastic epithelial cells, and multiple microgranulomas in the liver. Equine chlamydial abortion had not been diagnosed previously in South Australia. Eight days after examining the foetus and placenta, the veterinary pathologist developed fever and subsequently was admitted to hosp...
Policresulen is effective for the topical treatment of vaginal varices in a pregnant mare: Case report.
Journal of equine veterinary science    October 30, 2025   Volume 155 105711 doi: 10.1016/j.jevs.2025.105711
Miguel EL, Carneiro MFL, Griffo ALC, Baatsch Nascimento F, Dória RGS, Corrêa RR, Celeghini ECC.Vaginal varicosities in mares are rarely reported, although considered relatively common. Clinical recognition can be challenging, especially during early pregnancy, due to the intermittent nature of the bleeding. This report aims to describe the diagnostic approach, clinical evolution, and treatment of a case of vaginal varicosity in a pregnant mare, emphasizing a practical and minimally invasive method. A 9-year-old Brazilian Sport Horse mare with intermittent vaginal hemorrhage underwent clinical evaluation, showing no abnormalities. Vaginoscopy with a rigid endoscope revealed varicose vein...
Fetometry in Arabian horses.
Frontiers in veterinary science    October 23, 2025   Volume 12 1689769 doi: 10.3389/fvets.2025.1689769
Ali A, Derar DR, Alaeyeari AA, Alharbi YM.This study aimed to monitor intrauterine fetal growth, establish predictive equations for gestational age estimation, and determine the optimal period for fetal sexing in Arabian horses using ultrasonography. Unassigned: Seven Arabian mares were monitored from insemination to parturition using transrectal ultrasonography. The following fetal and embryonic parameters were measured: embryonic vesicle (EV), crown-rump length (CRL), biparietal diameter (BIP), stomach diameter (STD), chest depth (CHD), abdominal diameter (ABD), kidney length (KDL), eyeball diameter (EBD), and eye lens length (ELL)....
Associations between immunological and hormonal parameters during healthy pregnancy in mares.
Theriogenology    October 22, 2025   Volume 250 117719 doi: 10.1016/j.theriogenology.2025.117719
Feijo LS, Ledeck J, Wolfsdorf K, Ponthier J, Parry S, Felippe MJB.Associations between the immune and endocrine systems during equine pregnancy remain poorly understood. Based on the hypothesis that distinct phases of the equine healthy gestation are characterized by specific associations between circulating immunological and hormonal parameters, contributing to pregnancy maintenance, this investigation aimed to: (i) evaluate how circulating immunological and hormonal parameters change across different phases of pregnancy; (ii) investigate associations between changes in circulating immunological and hormonal parameters; and (iii) propose potential hormonal ...
Duration of continuous fetal gastrointestinal peristalsis before parturition in mares maintained at a breeding farm or in a university hospital.
Theriogenology    October 17, 2025   Volume 250 117716 doi: 10.1016/j.theriogenology.2025.117716
Roxon CA, Deacon LJ, Abraham M, Stefanovski D, Sertich PL.Gestation length is not a reliable indicator of fetal maturity due to the variability of normal gestation length in the mare. A standard method to accurately predict equine fetal maturity is not being used clinically. The presence of continuous gastrointestinal peristalsis, as detected ultrasonographically, is an indicator that both human and canine fetuses are mature (can survive after elective cesarean section). To determine if continuous gastrointestinal peristalsis, which we termed Phase 5, was a valid indicator of fetal maturity in the horse, and whether this indicator varied in late-gest...
Expression pattern of the HIFα-family in equine chorioallantois during pregnancy and placental pathology.
Theriogenology    October 16, 2025   Volume 250 117714 doi: 10.1016/j.theriogenology.2025.117714
Boakari Y, El-Sheikh Ali H, Almeida GHDR, Scoggin KE, Fernandes CB, Marchio SP, Troedsson MHT, Carreira ACO.Equine placental dysfunction impairs fetal growth and disrupts pregnancy outcomes. Despite many advances in diagnosis, the molecular pathophysiology of equine placentitis and premature placental separation remains poorly understood. However, the hypoxia-inducible factor (HIF-α) pathway is related to placental hypoxia, and its modulation in placental diseases has been shown in other species. Therefore, we hypothesized that in conditions marked by equine placental dysfunction, oxygen deprivation in the chorioallantois membrane triggers the activation of the HIF-α pathway, which is related to m...
Treatment of luteal phase mares with the aromatase inhibitor letrozole does not change characteristics of the estrous cycle, ovarian function, and embryo characteristics.
Research in veterinary science    October 8, 2025   Volume 197 105935 doi: 10.1016/j.rvsc.2025.105935
Khan Y, Gautier C, Aurich C, El-Shalofy A.Letrozole is a potent and highly selective third-generation aromatase inhibitor. In the present study, we aimed to investigate the effects of letrozole treatment of non-pregnant mares on estrous cycle characteristics. Cyclic, non-lactating mares (n = 9) were included. After estrus synchronization, mares were monitored to detect ovulation (d0:) of the treatment cycle. Each three mares were randomly assigned to one of three treatments: control, 0.5, and 1 mg/kg body weight letrozole in three consecutive cycles (d7 to d13 of the treatment cycle). Mares were inseminated in the estrus after trea...
Prediction Values for the Influence of Fetal Sex on Plasma Progesterone Concentration in Crioulo Breed Mares: A Preliminary Investigation.
Reproduction in domestic animals = Zuchthygiene    October 7, 2025   Volume 60, Issue 10 e70131 doi: 10.1111/rda.70131
de Lara NSS, Weiss RR, Oba E, Kozicki LE, Souza FA, Bergstein-Galan TG, Muehlbauer E, Silvestri M, de Lima PHL, Vaz ES.In equine reproduction, determining foetal sex is of economic and strategic importance, but currently available methods are often invasive, costly, or require specialised expertise. This study aimed to assess whether plasma progesterone concentrations could serve as a predictive tool for foetal sex determination in Criollo mares between the 4th and 8th months of gestation and to determine whether these measurements could identify foetal sex. Blood samples were collected at 30-day intervals from 17 Crioula mares between 114 days and 240 days of gestation. Maternal plasma progesterone concen...
Incidence of spontaneous ultrasonographic regression of the corpus luteum in pregnant embryo recipients and broodmares: a field study.
Theriogenology    October 3, 2025   Volume 250 117700 doi: 10.1016/j.theriogenology.2025.117700
Newcombe JR, Claes AN, Cuervo-Arango J.Early embryonic loss (EEL), particularly between Days 14 and 42 of pregnancy, remains a key concern in equine reproduction. This study investigates the incidence of spontaneous luteolysis-used here as a marker of maternal recognition of pregnancy (MRP) failure-in both pregnant Thoroughbred (TB) broodmares and recipient mares carrying either in vivo-derived (IVD) or in vitro-produced (IVP) embryos. Retrospective reproductive data from 2078 pregnancies in TB and 532 pregnancies in recipients were analysed to determine the incidence and characteristics of clinical luteolysis during pregnancy. Ove...
Midline vs. flank laparotomy- criteria for choosing the optimal surgical technique for uterine torsion correction in the mare.
BMC veterinary research    September 24, 2025   Volume 21, Issue 1 542 doi: 10.1186/s12917-025-04883-w
Samsel J, Gündemir O, Szara T, Witkowski M.Uterine torsion in mares belongs to maternal pregnancy disorders, accounting for 5-10% of complications in the last trimester of pregnancy. Two surgical techniques for repositioning uterine torsion are used: flank laparotomy in local anesthesia on a standing mare (SFL) and midline laparotomy carried out under general anesthesia (MI). The study aims to present the exact protocol used by the authors to qualify a mare with uterine torsion for surgery using one of the above-mentioned methods.A total of 19 mares were operated on, of which 13 underwent midline laparotomy under general anesthesia, an...
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