Pathophysiology, classification and treatment of vaginal prolapse in cows Flashcards
Etiology
- Last trimester of pregnancy
- Hormonal changes (E2, relaxin)
- Wall of the vagina protrudes through the vulva
- Four stages
Classification of vaginal prolapse
• Grade one – two - three – four prolapse
Classification of vaginal prolapse
Grade one prolapse
- Intermittent prolapse
- Visible when lying down, retracts when standing up
- Irritation: second phase
Classification of vaginal prolapse
Grade two prolapse
- Continous prolapse without major tissue damage, urinary bladder retroflexed – urination problems
- Can be easily replaced
- Further irritation – third phase
Classification of vaginal prolapse
Grade three prolapse
- Both the cervix and almost the entire vagina is prolapsed
- Major irritation, local edema, hyperaemia, compression of blood vessels
- Difficult to replace
- If cervical seal is disturbed: danger of imminent septic abortion – elective C-section
- Signs of toxaemia indicates fetal death
Classification of vaginal prolapse
Grade four prolapse
- Prolonged prolapse
- Grade two or three with infection, trauma or tissue necrosis
- Possible adhesions between perivaginal tissue and adjacent organs (bladder)
- Peritonitis: present or imminent
- Subacute form is replacable but chronic is irreplacable, poor prognosis, euthanasia
Replacement of vaginal prolapse
Preoperative measures
- Epidural anaesthesia
- Clean and disinfect the prolapsed vagina and the surrounding area
- Hygroscopic powder: sugar, sulpha urea –decrease local edema
Replacement of vaginal prolapse
Operation techniques
Several options, depending on the expected date of parturition and environmental factors
I. Flessa method
II. Buhner method
III. Lacing of the vulva with mattress sutures (vertical/horizontal)
IV. Episioplasty (Caslick’s operation) – mainly in horses
Replacement of vaginal prolapse
Flessa method
- Pierce the vulva with the pins with spacers on both sides (number of pins used depends on the size of the vulva)
- Leave the ventral third of the vulva intact to keep urination undisturbed
- Remove pins when parturition starts
Replacement of vaginal prolapse
Buhner method
• Equipment: Buhner needle and antibiotic-soaked tape
• Horizontal skin incisions: dorsal and ventral commisure of the vulva
• Insertion of a loop of tape under the skin of the vulva:
o Stimulates the action of the constrictor vestibuli muscle
• Needle is directed through incision at ventral commissure of vulva
• Suture material is threaded through exposed eye of needle
• Second limb of suture is carried around left side of vulva
• The suture is pulled out and tied at the vulvar incision
• Tightened suture: enough space for 2 or 3 fingers in the vulva
• Use bow knot for maintaning the closure
• Circular constriction is formed
• Incisions: closed by interrupted sutures
• Easy to open when parturition starts
Replacement of vaginal prolapse
Lacing of the vulva with mattress sutures
Advantages:
• Simplicity, easily removable
• No special equipment needed
• Secure
Technique
• Widely placed mattress sutures encircle vertically placed quills of rubber tubing (infusion tube)
• Vertical or horizontal mattress sutures
• Remove when parturition starts
Replacement of vaginal prolapse
Episioplasty (Caslick’s operation)
Technique
• 1.8 cm band of the mucosa removed to about 4 cm above the ventral commissure
• Closure of the vulvar lips: vertical mattress suture, nonabsorbable material
• Parturition: open surgically
Complications
- Fecal contamination of pins/tape/sutures – risk of infection – inflammation, fetal death
- Lack of close observation before parturition – obstructed vulvar opening – fetal death
- Vaginal wall edema – compression of urethra – difficult urination
- Vaginal wall edema – stricture – dystocia – C-section
- Scar tissue formation in the vulva – dystocia – episiotomy
- Might relapse after parturition – repeat operation/cull
