11th Lecture

Genital Prolapse
 Uterine prolapse or eversion of uterus

• Also called casting withers or casting of calf bed.

• Common in cow and ewes, rare in mare, dogs and cats.

• Just after parturition OR may occur up to 45-72 h after

parturition

• Incidence varies from 2-3/1000 calvings.

• Occur in all age groups but the highest incidence in

pluriparous, aged, debilitated and poorly grown animals.
 Continued

• The understandable or convincible force that could

lift the heavy uterus out of abdomen into pelvis &
then propel outside are
• 1. Abdominal straining.

• 2. Gravity acting through medium of sloping floor

• 3. Traction force by variable weight of dependent

afterbirth containing loculi having uterine fluid or
urine.
 Etiology
• Exact cause is not known but certain factors may
predispose the uterus to prolapse & may include

1. Long mesometrium attachment.

2. Violent/Aggressive strong tenesmus.(may be because of

Pain/discomfort after parturition)

3. Relaxed, atonic and flaccid uterus.(poor uterine tone or uterine

inertia)

4. Retention of fetal membranes at the ovarian pole.(heavy

weight of RFM or excessive traction)
 Continued

• Commonly seen in confined animals when they

calve on floor with their hindquarter sloping
downward & hanging over the gutter.

• Forceful fetus traction also predispose the animal

to uterine prolapse because in dystocia when the
uterus is tightly contracted around the dry fetus &
the forced extraction is likely to result in prolapse.
 How it occur
• Eversion commences with intussusceptions or
invagination of the pregnant horn at the ovarian
end that may begin during the expulsive stage of
the labor or soon after the birth of the fetus.
• The invagination gradually progresses towards
posterior until the entire organ becomes everted.
• It then quite suddenly prolapses through the vulva
when abdominal straining commences.
• Once it occur then severe congestion strangulation
& edema develops rapidly & is followed by necrosis
& sepsis.
 Clinical symptoms
• Usually recumbent but sometime standing with
uterus hanging to the hock.
• The everted surface covered with fetal membranes
& if removed or sheds then the entire
endometrium is red but the caruncles are darker
than the intercaruncular area.
• Usually the prolapsed mass is lacerated,
hemorrhagic & soiled with feces, mud & bedding
material.
• The animal feels considerable restlessness, pain
sometime tenesmus may be present.
 Continued
• Prolapsed mass is usually enlarged & edematous
especially if the condition has existed for 4-8 hours
or longer. In cow the gravid horn prolapsed
sufficiently so that the cervix is usually present at
the vulva.
• The non-gravid horn is held inside the peritoneal
surfaces of the prolapsed gravid horn & doesn't
evert because of strong intercarnual ligament.
• The opening of the non-gravid horn may be
observed as an oval or slit like orifice near the vulva
on the ventral or lateral side of the prolapsed gravid
horn.
 Prognosis
• The prognosis depends on
1. Length of time the prolapsed mass has been existed.
2. The degree of trauma to the organ.
3. Extent of soiling/contamination.
4. The degree of viability of the tissues.
5. Presence of shock due to hemorrhages etc.
 Continued
• If exist for longer time then edema increases & be
more difficult to correct the condition & chances
for laceration & blood loss also increases.

• If there is excessive endometrial trauma, the

greater are the chances for infertility.

• Infection/contamination of the prolapsed mass

rapidly leads to peritonitis & toxemia especially
when organ is replaced as such.
 Continued
• Prognosis is very grave if larger part of uterus
becomes necrotic.

• Prognosis for survival of the dam depends on

exact & correct interpretation of the clinical signs
& choice of most proper therapeutic measure i.e.
homeostasis, treatment for shock & repositioning
of the organ.
 Rx
• Farmers must be instructed to wrap the prolapsed
uterus in a wet towel or plastic bag so as to keep
it moist & clean until replaced.
• Uterus must be raised to the level of vulva until
assistance arrives.
• This prevents the uterus from becoming
edematous & may possibly prevent rupture of the
uterine artery.
• Proper restraint of the animals as well as epidural
anesthesia( lignocaine 2% 6 mls.) facilitate uterine
replacement.
 Continued
• The hindquarter should be elevated so as to
facilitate the repositioning of the uterus.
• In case of hypocalcaemia, an intravenous infusion
of calcium borogluconate ( 250 to 500 mls.)will be
helpful. Otherwise fatal regurgitation and
aspiration of ruminal contents may result.
• If laceration & hemorrhages are present, ligating
the bleeding vessels must provide hemostasis &
suturing of deep & perforating laceration should be
performed.
 Continued
• Fetal membranes, if present should be removed gently,
without severe trauma & hemorrhages otherwise may be
left in place.
• Wash & clean the prolapsed mass with warm physiological
saline solution or with water to which a small amount of
mild antiseptic has been added.
• Some Vets. use 30-50 units of oxytocin intramyometrial to
contract/involute & decreases chances of reoccurrence of
prolapse but sometime this treatment makes the uterus
tense, contracted & difficult to replace it in normal
position.
• The use of glycerol helps in the reduction of edema &
provide lubrication.
 Procedure for replacement
 In replacing the uterus, it should be held above
the level of the floor of the pelvis.
 Vulvar lips should be pulled apart.
 1st ventral portion & then dorsal part of the
prolapsed mass should be replaced, starting at the
cervical end of the uterus nearest the vulva.
 In replacing the uterus pressure should be exerted
with palm of hand with finger extended to avoid
perforating the uterus.
 Continued
• Finally the fist through the vulva, vagina & cervix
pushes the ovarian pole into the uterine lumen.
• Push the ovarian pole with clenched fist & arm by a
piston like motion on various parts until the horn is
completely straightened out & no invagination
remains.
• If complete replacement of ovarian pole is difficult,
the introduction of 2-3 gallons of very hot water/
physiological saline solution into the uterine cavity is
often helpful.
• It stimulates uterine contraction & usually siphoned
out back with uterine debris.
 Continued
• After replacement, oxytocin 30-50 units I/V is
given & contraction occurs within 30-60 seconds.
Repeat this treatment after 2-4 h interval
• Antibiotics are used to prevent secondary bacterial
infection.
• To retain/prevent reoccurrence of prolapse, apply
truss or Buhner’s technique or others techniques
as in vaginal prolapse .
 Rx for genital prolapse
• It varies with
1. Species
2. Severity of case/condition & stage of pregnancy
 In mild cases  slight protrusion  when cow lies
down & disappear when rise up
 In this case animal is removed from slopping surface &
placed where her hind quarter remain 24 inches higher
than the front quarter.
 This help in preventing the case from becoming more
severe
 Continued
 P4 is used 50-100mg I/M daily
or
 500 mg once every 10 days.
While replacing uterine prolapse, epidural anesthesia 5-10 cc
2% lignocaine is used.
Animal in standing position with hind quarter elevated,
facilitate replacing of prolapsed mass.
Wash prolapse mass with mild antiseptic/non-irritating
 if irritation/infection/straining, use antiseptic ointment before
replacing & is put/injected once/twice daily for several days
Buhner’s Technique
To retain/prevent the
Truss reoccurrence