Vagino-cervical prolapse Flashcards
Prolapse of the vagina usually involves
prolapse of the floor, the lateral walls and a portion of the roof of the vagina through the vulva with the cervix and uterus moving caudal.
Vaginal prolapse usually occurs during
the early postpartum period or during the last trimester of pregnancy.
Classification of vaginal prolapse is done according to duration and severity of the condition:
1st- 3rd degree
1st: slight intermittent protrusion of the floor of the vagina when the cow is lying down (also called inversion of vagina).
2nd: the vagina protrudes continuously.
3rd: majority of the vaginal floor, sometimes bladder, and the cervix, continuously protrudes from vulva.
Describe 1st degree vaginal prolapse.
First degree of vaginal prolapse is slight intermittent protrusion of the floor of the vagina when the cow is lying down (also called inversion of vagina, occurs during last trimester of pregnancy).
First degree prolapse frequently proceeds to second degree prolapse. The wall of vagina protrudes through the vulva continuously.
Describe 2nd and 3rd degree vaginal prolapse.
In second degree, the vagina protrudes continuously. Partial prolapse.
In third degree, the majority of the vaginal floor, sometimes even including urinary bladder and the cervix, continuously protrudes from vulva. Also referred as cervical prolapse or total prolapse.
In third degree, the cervical opening is visible in the middle of prolapsed tissue.
Risk factors for vaginal prolapse. (4)
Pregnancy
Relaxation of paravaginal tissues and increase in abdominal cavity pressure.
In heifers, very occasionally (beef heifers).
Quite often in multiparous cows. Incidence increases after 5th lactation. The older the cow, the bigger the risk.
No direct relation between antepartum and postpartum prolapse of vagina.
Postpartum prolapse often associated with
injuries during parturition which can cause straining after parturition.
Causes of vaginal prolapse. (9)
Primary cause is relaxation of perivaginal tissue ligaments.
Poor vulvar/vaginal conformation
Endogenous or exogenous estrogens
Previous injury to perivaginal tissues
Intake of large volumes of poor quality roughage (e.g. molds (zearalenone toxin))
Excessive perivaginal fat
Hereditary predisposition
All diseases which may cause strong labors or straining
Short cubicles which slant downwards, low motion activity
Why does zearalenone cause vaginal prolapse?
zearalenone mycotoxin mimics estrogen - is a natural pseudoestrogen, behaves as such biologically.
thus when cow fodder is poor quality and contaminated with this toxin, the perivaginal tissue ligaments will loosen over time.
Clinical signs of vaginal prolapse.
May vary from a mild protrusion of the vaginal mucous membrane through the vulvar lips when the cow lies down, to a severe necrotic vagino-cervical prolapse containing a greatly distended bladder and complicated by prolapse of the rectum due to constant tenesmus.
In mild cases the prolapsed vaginal wall returns to its proper position when the cow rises.
When it occurs in the middle of pregnancy it may turn to partial or total prolapse (second or third degree).
Consequences of prolapse to the affected organs.
Manure contamination
Mucus membrane injuries develop
Edema occurs because of the irritation and trauma to the exposed mucous membrane.
Degree of vulvitis, vaginitis and cervicitis will vary, depend upon duration of condition + type of mechanical, thermal or infectious agents acting upon the prolapsed mucous membranes.
Edema tends to accumulate in the submucosa and cause a separation of the mucosa from the underlying thin muscular vaginal wall.
The cervical seal usually remains intact: although if the cervix is prolapsed and inflamed, the external portion of the seal may be absent.
Occasionally the cervix relaxes, the cervical seal is lost and abortion or premature parturition occurs within 24 – 72 h.
All the above lead to injuries during birth process as the outcome will be loss of normal vaginal elasticity (lot of connective tissue).
Diagnosis of vaginal prolapse.
According to visual inspection
vaginal prolapse with one horn uterine prolapse
Reduction of this would start with reduction of the vagina and only then the uterus.
DDx for vaginal prolapse (4)
Vaginal tumors, vaginal masses
Gartner’s duct cysts, cystic Bartholin’s glands
Perivaginal hematoma
Uterine prolapse
Describe Vaginal tumors in cattle.
Sausage like shape, thick consistency (quite rare), mainly papillomas.
Palpation, stalk of the tumor is usually on the borderline of vestibulum and vagina.
Diameter 2–12 cm length ca 20 cm
Treatment is surgical (low sacral-epidural anesthesia)
Describe surgical resection of vaginal tumor in cattle.
After low epidural-sacral anesthesia:
Tumor is pulled out from vagina very slowly, so that stalk of the tumor will be visible from vulva (15 – 20 min).
Then a ligature is placed on the border where the tumor stalk is attached to mucosal membrane.
2 cm above the ligature we cut off the tumor
Necrotic stump of tumor will be expelled together with ligature after 10 – 12 days.
Describe Bartholin’s gland cysts in cattle:
From vulvar lips, rounded hand size structure with glossy surface is visible.
Usually unilateral, and darker in color than prolapsed vaginal mucous membrane.
Caused by closure of ducts or duct openings (trauma, inflammation).
Treatment is surgical (simple and effective):
Opening of the cysts by 5 – 6 cm long cut, let the liquid flow out and flush the cyst walls with iodine solution.
Buhner’s needle and tape
Buhner’s purse-string suture
Constriction of the vulva using Caslick’s vulva-suturing operation as modified by Roberts.
