Bovine prolapsed uterus

Bovine prolapsed uterus refers to the abnormal positioning of the bovine uterus after calving. It is most common in dairy cattle and can occur in beef cows occasionally with hypocalcaemia.[1] It is not as commonly seen in heifers, but occasionally can be seen in dairy heifers and most commonly Herefords.

Prolapsed uterus in a cow

Uterine prolapse is considered a medical emergency which puts the cow at risk of shock or death by blood loss.[2] Factors that increase the risk of having a uterine prolapsed include: calving complications that causes injury or irritation of the external birth canal, severe straining during labour, or excessive pressure when pulling out a calf.[3] Non-calving factors include: nutrition problems such as low blood calcium, magnesium, protein, or generally poor body conditions.[4]

It is common for a complete uterine prolapse where the uterine horns also come out. When this happens, the uterus will hang below the hocks of the animal.[1] When the uterus hangs below the hocks, the cow may lie on, step on or kick the exposed tissue, which increases the risk of rupturing a major artery.[5] The uterus can become easily infected as it bruises easily and can become covered with manure.[5]

Causes

Uterine prolapse occurs after calving when the cervix is open and the uterus lacks tone.[6] It occurs most commonly hours directly after calving, but may also occur up to a week post-calving.

When the uterine prolapse does not occur directly after calving, it can be more dangerous for the cow. It is most likely that during parturition, the uterus was slightly everted, which suggests that the prolapse did not take place until after the calf was born.[1] In these cases, the uterus is more likely to be infected. This increases the possibility that the uterus cannot be replaced in the animal, and instead must removed.[1]

Treatment

When a cow suffers a uterine prolapse, there are two option of treating it: reduction or amputation.[1] In extreme cases, the cow may have hemorrhaged and suffered intense shock and therefore will be euthanized.

When choosing as treatment, there are a few considerations to take:

  • Placenta. It is possible that the placenta has already separated from the uterus but in other cases it has to be manually removed. It is extremely rare to not be able to separate the placenta from the uterus after a prolapsed.[1] If, in this rare cases, the placenta is not able to be removed, it cause problems as it is impossible to adequately clean the dirt if it has been on the ground and this dirt will interfere with the reduction. It would be possible to cut around each cotyledon and clean the rest as thoroughly as possible and replace.[1]
  • Trauma. If the trauma is too severe, it is not recommended to perform a reduction. The trauma or exposure to the environment could cause devitalization of the uterus and if it is too severe, it could cause further problems if placed back inside.[1]
  • Gross hemorrhage. If there is a lot of hemorrhaging, then there is no reason to perform the reduction and therefore amputation is the preferred option. Gross hemorrhaging can occur when there is a scared animal that is unable to be restrained. If violent struggling or running occurs with the prolapsed uterus, it can cause extreme distress, coma and death.[1]

If the treatment is reduction, then the placenta will be removed, the endometrium thoroughly cleaned, any lacerations fixed and placed back in the right position. If amputation is the course of action, the uterus is removed.[1]

During treatment of a prolapsed uterus, the animal must be positioned correctly to avoid increase bloat. A bloated rumen can make it much more difficult to perform a reduction.[1]

Prevention

There is no way to completely prevent uterine prolapse. To reduce the risk of uterine prolapse, cows are returned to a standing position and encouraged to move around as soon as possible. This is especially important in cases where a calf is pulled to assist the mother. A cow that is returned to an upright position drops the uterus back into the abdominal cavity which straightens out the uterine horns.[5]

Prognosis

The prognosis is generally favorable if the cow survives having the uterus replaced, and most cows survive into the long term.[7]

Normally, if a prolapsed uterus is placed back into the animal correctly there are no further complications. However, there is a chance that a secondary infection can occur which can cause the cow to be slow to re-breed or even unable to be re-bred at all. Although genetics does not make a difference in the risk of prolapsing again, cows that have had a prolapse are more likely to have another compared to cow that have never encountered a prolapse.[2]

Differential diagnosis
Vaginal Prolapse

Uterine prolapse can often be confused with vaginal prolapse. A vaginal prolapse is a small pink or red ball of tissue ranging from the size of a grapefruit to a soccer ball. It is expelled from the animal before calving, whereas a uterine prolapse takes place after calving.[5] It occurs when there is an increase in pressure in the abdominal cavity during the late stages of parturition.[2] It is more common than a uterine prolapse and can also be passed by genetics. It is quite common for a vaginal prolapse to occur in the same animal each time they calve but a uterine prolapsed is not reoccurring.

Other species
Prolapsed uterus in a ewe

Prolapsed uterus can occur in any species but cases are most common in dairy and beef cows and ewes. Although it can occur in any species, it is less common in sows and is rare in mares, felines and bitches and rabbits.[6]

References
  1. "Treatment of prolapsed uterus in cattle [Vet Postgraduate Foundation, Sydney]". homepage.eircom.net. Retrieved 2019-03-28.
  2. Ward, Heidi; Powell, Jeremy. Reproductive prolapses of cattle (PDF) (Report). University of Arkansas. Retrieved 2019-12-16.
  3. Senger, Philip (1997). Pathways to Pregnancy & Parturition (3rd ed.). Pullman, WA: Current conception inc. ISBN 096576480X.
  4. "Uterine prolapses and a Vaginal prolapses in cattle". Moocall. Retrieved 2019-03-29.
  5. Thomas, Heather (2009). Storey's Guide to Raising Beef Cattle. Storey Publishing. pp. 205–206. ISBN 978-1-60342-455-4.
  6. "Overview of Uterine Prolapse and Eversion - Reproductive System". Merck Veterinary Manual. Retrieved 2019-03-28.
  7. Rees, Gwen (14 January 2016). "Postpartum emergencies in cows". In Practice. 38 (1): 23–31. doi:10.1136/inp.h6407.
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