Diseases - Sheep

Prolapse Of The Uterus

Species

All. Cattle are the main species of interest.

Description

Uterine prolapse describes the situation where the uterus everts through the birth canal to hang behind the animal with the interior surface (endometrium) visible.

Prolapse usually occurs immediately following calving while the cervix is still open and the uterus still flaccid. Prolapse may be predisposed by difficult birth or hypocalcaemia.

Uterine prolapse is followed by oedema, inflammation, swelling and risk of traumatic damage to the exposed organ. The uterine ligaments and associated blood vessels may stretch and tear and there is a risk of serious and possibly fatal haemorrhage. In addition involvement of the bladder and possibly intestines in the prolapsed may result in urinary or intestinal obstruction.

Because heavily pregnant cattle are usually excluded from the export process, uterine prolapse will be rare.

Clinical Signs and Diagnosis

A uterine prolapse presents as a large mass of tissue hanging from the vulva, often past the level of the hocks. The amount of prolapsed tissue and the presence of large numbers of caruncles (the discrete mushroom-like lumps of uterine tissue which attach to the placental cotyledons), enables differentiation of uterine prolapse from retained foetal membranes, and prolapse of the rectum or vagina.

Treatment

Treatment should not be delayed. Affected cattle should be handled very gently as there is a high risk of blood loss and shock. If standing they should be slowly walked to a crush with a head bale, if recumbent they should be tied up with a halter.

Wash the prolapsed tissue with warm soapy water, repair lacerations and remove placenta carefully if still attached. If there is excessive bleeding then stop trying to peel the placenta away from the caruncles. Apply glycerol to reduce oedema and lubricate in preparation for replacement.

Caudal epidural anaesthesia will prevent straining during replacement. If standing, use a tray or chaff bag held between two assistants to elevate the prolapse. If recumbent, position in sternal recumbency with hind limbs stretched backward to tilt pelvis forward and aid repositioning.

If bladder or intestines are contained within the prolapse these should be repositioned first by pressure applied gently through the uterine wall. A urine distended bladder may need draining with needle and catheter passed through uterine wall. Ensure both horns are completely everted once the uterus is returned to the inside of the body. If this is done properly, there is usually no need for insertion of a perivulvar suture to prevent recurrence. Administer oxytocin and calcium borogluconate solutions to promote uterine contraction. Antibiotic pessaries inserted into the uterus are unnecessary. Instead, systemic antibiotics (procaine penicillin, oxytetracycline, or trimethoprim sulpha) should be administered daily for 3 to 5 days.

If severely necrotic or traumatised the uterus may require amputation or alternatively euthanasia may be warranted on welfare grounds.

Prevention

Specific preventative measures are unwarranted in the live export process. Awareness of the condition, especially its occurrence at calving and the need for prompt intervention is sufficient.

Syndromes