In dairy cattle, the condition is not thought to be inherited and seldom recurs in subsequent parturitions. Although the exact cause for an individual patient may be difficult to determine, predisposing causes include dystocia, tenesmus, and hypocalcemia. Primiparous cows can be affected, but pluriparous ones are probably at greater risk. Prolapse of the uterus also is fostered by confinement, lack of exercise, and gravitational effects when cattle are allowed to calve with their hindquarters lower than their forequarters, as happens when confined cows calve into the drop of conventional barns. Uterine atony is the common inciting cause and is frequently associated with hypocalcemia in multiparous dairy cattle.
Prolapse usually occurs within hours of calving and almost always within 24 hours of calving. Instances of uterine prolapse occurring several days following calving are cited by many practitioners but are extremely rare.
Clinical Signs and Diagnosis
The clinical signs are dramatic and suffice for definitive diagnosis. Occasionally neophyte handlers or those privileged to have never seen the condition will confuse uterine prolapse with vaginal prolapse, but the sight of a fully prolapsed uterus is difficult to confuse with other conditions. Conspicuous placentomes on the exposed endometrium make the prolapsed uterus impossible to confuse with any other organ. The cow may appear healthy otherwise; this is often the case in primiparous cattle. Pluriparous cows with uterine prolapse often show varying degrees of hypocalcemia such as weakness, depression, subnormal temperature, anxiety, struggling or prostration, and coma. Tenesmus is common to most cases. Signs of shock should be differentiated from those of hypocalcemia because a small percentage of prolapse patients may develop hypovolemic shock secondary to blood loss (internal or external), laceration of the prolapsed organ, or intestinal incarceration within the prolapsed organ. Extreme pallor, a high heart rate, and prostration are grave signs in such cattle. Rarely the cow is found dead, especially when an unobserved calving has occurred. The prolapsed uterus often is heavily contaminated with bedding, feces, dirt, and placenta. Some bleeding is common from exposure injuries to the placentomes or endometrium. If the affected cow is able to stand and walk, the massive organ hangs near the hocks and can be stretched, traumatized, or lacerated as it fl ops back and forth against the rear quarters.
Uterine prolapse is one of the true emergencies in bovine practice, and rapid owner recognition followed by prompt veterinary treatment greatly improves the prognosis.
When notified of the condition, the veterinarian should instruct the owner to keep the cow quiet and to cleanse the exposed organ and keep it moist. Warm water containing dilute (1%) iodine and a clean towel or sheet work well for this purpose. If possible, the owner also may be instructed to elevate the organ to the level of the ischium or higher to relieve vascular compromise and subsequent edema, as well as lessen the chance of injury. When the veterinarian arrives at the scene, overall assessment of the situation is in order before proceeding with specific treatment. The cow’s position, overall physical status, and the environment should be assessed. Specifically:
This overall assessment and a very quick history and cursory physical examination can be completed within minutes and may improve the end results greatly.
Specific treatment is subject to great individual variation as regards when to administer calcium, whether to perform the repair with the patient recumbent or standing, when to give certain drugs, and aftercare. The basic premises are, however, agreed on by most practitioners.
The cow already may be able to stand, or the veterinarian may choose to treat the cow for hypocalcemia and allow her a short time such that she may stand for the procedure. Recumbent cows on a fl at surface that have the hind legs pulled behind them so they are in sternal recumbency and the hind legs pulled caudally so the animal lies on the cranial stifle areas are easier to correct, but this position may predispose to coxofemoral injury if the cow struggles to get up. This tips the pelvis forward and allows a mechanical and gravitational advantage. If the cow is in an uneven posture, it also may be possible simply to angle her front end downhill to give significant mechanical advantage.
In difficult situations where labor is unavailable or the environment is not conducive to gaining a mechanical or gravitational advantage, hip slings can be used to elevate the cow’s rear quarters to hasten replacement. In some cases it may be possible to hoist the hindquarters of the cow using farm equipment such as a skid steer.
While this does facilitate replacement of the uterus, care must be taken to support the uterus as the cow’s hindquarters are raised. Excessive tension on the prolapsed uterus may result in rupture of the uterine artery, already compromised by stretching in the prolapsed organs.
At this time, the tip of the horn is identified, and hand and arm pressure is exerted to evert the horn and uterus completely back into the abdomen. Once everted, the organ should be rocked gently and shaken to ensure complete eversion of the horns and minimize the chances of reprolapse.
Some practitioners also use a bottle as an “arm extension” to aid in complete eversion of the horns. It is very important to completely evert both gravid and nongravid horns to prevent tenesmus from causing reprolapse after the epidural wears off.
Retention sutures placed in the vulva following replacement of uterine prolapses are also controversial. They are ineffective for prevention of reprolapse and may rarely mask the condition by allowing the uterus to become trapped in the vagina. Since the common predisposition for uterine prolapse is uterine atony, complete restoration of the uterus to its normal position and treatment to enhance uterine tone are sufficient to prevent recurrence of the condition.
The prognosis for uncomplicated uterine prolapse is good, and most cows that respond promptly will breed back following routine monitoring and treatment of their metritis. Furthermore, dairy cows that have had prolapses do not have a higher incidence of the problem at future calvings. Of cows with uterine prolapses, 75% or more should do well.
Of cows that do not do well, a low percentage will reprolapse within 1 to 3 days, some cannot be replaced at all, some die as a result of intestinal incarceration in the prolapse or bleed out, some develop severe peritonitis or perimetritis from uterine tears, and some do irreparable damage to the prolapsed organ. The owner should be made aware that the cow could die at any time during or following replacement when shock is obvious. Reprolapse is an extremely bad sign, and cows that repeatedly prolapse after initial correction seldom do well. It is wise to reexamine all prolapse patients 3 days after repair to assess the overall systemic state and make specific recommendations regarding metritis or uterine injury. Decisions on further antibiotic and other therapy can be discussed with the owner at this time.
FMD is a highly contagious disease
The normal blood calcium concentration in adult cows is between 8.5 and 10 mg/dl, which translates into a total plasma pool of only about 3 g in a 600-kg individual. It is evident that to meet the calcium needs of colostrums production, fetal maturation, and incipient lactation at the end of gestation (collectively these requirements may reach 30 g/day), adult cows will need to mobilize substantial amounts of calcium from bone and increase the efficiency of gastrointestinal tract absorption.
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