72. Small ruminant medicine: prolapse of the uterus and vagina Flashcards
Vaginal prolapse incidence?
Vaginal prolapse
Incidence
• 1% (0–15%) 8 cm to 20 cm vaginal wall urinary bladder, and/or uterine horn(s) or both of these
during the last month of gestation
Vaginal Prolapse aetiology?
Aetiology
- excess body condition
- multigravida uterus
- high-fibre diets, particularly root crops
- lameness
- steep fields
- subclinical hypocalcaemia
- short-docked tails
- abdominal straining
Consequences of vaginal prolapse?
Consequences
• prolonged straining →
o premature onset of labour or abortion
o pregnancy toxaemia
o Rupture of the dorsal vaginal wall and evisceration
Diagnosis of vaginal prolapse?
Diagnosis
- Difficult (extra care is needed)
- Undocked tails
- Long fleeces
- Extensively managed systems
- Good lighting is essential to examine housed sheep
Clinical signs of vaginal prolapse?
Clinical signs (first stage of labour):
- isolation from the remainder of the flock
- Failure to come forward for concentrate feeding
- Lateral recumbency with repeated
- Forceful abdominal contractions and associated vocalization
- increased respiratory rate
- frequent urination without urine
- neither cervical mucus plug nor foetal membranes are visible
- contamination with faeces, bedding material and soil
- vaginal wall quickly becomes oedematous and turgid
- rupture during manual replacement
- effective caudal analgesia
- increase toxin uptake
- fibrin exudation on the surface
- particular attention should be paid to the cervix
- haemorrhage
o externally from tears in the vaginal wall
o pale mucous membranes
o significant internal bleeding
Viability of foetuses?
Viability of the foetus(es)
- Transabdominal real-time B-mode with a 5 MHz sector transducer
- Foetal heartbeat, difficult to detect in near-term foetuses even after searching for 5 minutes
- US findings only indicate the presence of one or more live foetuses at the time of examination
- If no foetal movement is detected after 5 minutes → the foetuses are dead
- foetal membranes in the cervix → indicates impending abortion/parturition →immediate action
- caesarean operation
o foetal membranes appear normal
o hopeless when there is a foetid vaginal discharge.
US urinary bladder and vaginal prolapse?
The vaginal prolapse
• Urinary bladder, uterine horn(s) or both
Urinary bladder
- An anechoic (black) area
- Usually greater than 10 cm in diameter
- Compressed dorsoventrally
Treatment of vaginal prolapse?
Treatment
• Standing ewe + caudal block (hindlimb paresis) + prolapse is raised relative to the vulva→ emptying
of the bladder
- Puncture ↔ allanto-chorion and/or vessels
- Closing the vaginal gap:
o Buhner suture
o Single interrupted and mattress sutures ?
o Hindlimb paresis → well-bedded pens for 36 hours
o Permanent prolapses → culling
Closing the vaginal prolapse, complications?
Closing the vaginal gap
• Harnesses
o Difficult to fit
o Faecal contamination
o First stage of labour!
• Plastic retention devices
o Tied to the fleece of the flanks
o In early cases but can cause irritation
To
- No more tenesmus → Buhner suture be untied 3–4 days later
- First stage of labour
Complications
- Abortus within 24-48 hours, foeto-placental unit
- Incomplete cervical dilation
Uterine prolapse incidence and cause?
Uterine prolapse
Incidence:• Immediately after lambing or within 12–48 hours
Cause:
- Large singleton foetus + prolonged 2. stage of parturition
- Unskilled assistance → pain, abdominal straining → dystocia
Treatment and management of uterine prolapse?
Treatment:
- Epidural anaesthesia
- Reposition
- Buhner method
- After reposition restraining → invagination?
- AB, NSAID
- Probability of re-prolapse → breeding
Management:
• Timely correction of the dystocia by a veterinary surgeon
