Pathophysiology, clinical aspects and treatment of uterine prolapse in cows

Question 1

When?

Answer 1

• 12-24 hours after calving

* Sporadic, more commin in dairy

Question 2

Etiology

Answer 2

• dystocia, prolonged straining
• excessive traction
• hypocalcaemia
• uterine inertia

→Acute, life-threatening problem!

Question 3

Clinical aspects

Answer 3

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

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

Question 4

Preparations for the replacement of uterine prolapse

Answer 4

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

Question 5

Evaluate the surface for tearing and perforations

Answer 5

• Less than 2 to 3 in and dorsal (most common), not
• Full-thickness lacerations should be repaired
• simple continuous pattern
• vertical mattress sutures (tension)
• Severe necrosis or circumferential lacerations, amputation of the uterus

Question 6

Replacement of the prolapsed uterus

Answer 6

• Less than 2 to 3 in and dorsal (most common), not
• Full-thickness lacerations should be repaired
• simple continuous pattern
• vertical mattress sutures (tension)
• Severe necrosis or circumferential lacerations, amputation of the uterus

Question 7

Replacement of the prolapsed uterus

Answer 7

• 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

Answer 8

• Dependent on timely intervention, parity, calf viability, and lack of secondary metabolic or musculoskeletal disease
• 2-week postincident survival of 72-80%
• 20% mortality resulting from shock (evisceration); blood loss; refractory downer cow
syndrome, and humane euthanasia.
• Conception rate after prolapse: 33-84%
• Decision to treat should be cost effective for the producer