49. Pathophysiology, clinical aspects, and treatment of uterine prolapse in cows

Question 1

Uterine Prolapse?

Answer 1

Uterine prolapse

• 12 -24 hours after calving
• Sporadic, more common in dairy

Question 2

Ethiology of uterine prolapse?

Answer 2

Etiology:

• dystocia, prolonged straining
• excessive traction
• hypocalcaemia
• uterine inertia
• Acute, life-threatening problem!

Question 3

Clinical aspects of uterine prolapse?

Answer 3

Clinical aspects:

• Uterus turns inside out and hangs from the vulva
• Blood flow is disturbed (veins are compressed) – oedema - possibility of shock, tissue necrosis
• Size and weight of the uterus increases

o difficult to replace

o suspension (broad ligament) can rupture - uterine artery severed – shock – sudden death

o another cow might step on it – uterine rupture – shock – death

• Mucosa exposed - infection

Question 4

First task to do the owner should do?

Answer 4

First Task

• while you are on the way, the owner/workers should hold the uterus up with a clean towel/cloth

Question 5

Preparations for the replacement of uterine Prolapse?

Answer 5

Preparations for the replacement of uterine prolapse:

• Epidural anaesthesia
• Hose down the uterus with COLD water and coat it with hygroscopic powder (sugar) to decrease the oedema
• Clean and disinfect the uterine surface and the surrounding area
• Sternal recumbency with hind legs extended behind the animal

Question 6

Evaluate the surface for tearing and perforations?

Answer 6

Evaluate the surface for tearing and perforations:

• Less than 2 to 3 in and dorsal (most common), not
• Full-thickness lacerations should be repaired

o simple continuous pattern

o vertical mattress sutures (tension)

• Severe necrosis or circumferential lacerations, amputation of the uterus

Question 7

Replacement of the prolapsed uterus?

Answer 7

Replacement of the prolapsed uterus:

• Gently push the uterus back into the pelvic cavity, then into the abdominal cavity, starting from the parts

closest to the vulva.

• Use fists or palm instead of fingers - risk of perforation
• The process can take long – helpers
• Once the uterus is replaced, insert a plastic tube into it and pump in approx. 20 l of lukewarm water with

iodine – weight – corrects possible invaginations, facilitates settling of the uterus in the abdominal cavity

• Drain the water (can be difficult)
• Use dry uterine treatment (uterine tablets) to prevent infections and oxytocin to increase muscle tone of the

uterus

• NSAID’s might be necessary if the animal is in pain
• Suture the vulva (see vaginal prolapse) to prevent another prolapse

Question 8

Prognosis of uterine prolapse?

Answer 8

Prognosis:

• Dependent on timely intervention, parity, calf viability, and lack of secondary metabolic or musculoskeletal

disease

• 2-week post incident survival of 72-80%
• 20% mortality resulting from shock (evisceration); blood loss; refractory downer cow syndrome, and humane

euthanasia

• Conception rate after prolapsing: 33-84%
• Decision to treat should be cost effective for the producer