Prolapsed uterus
Keywords: drawing, Trengrove, bovine, calving, accident, prolapseAuthor: Dr Ronald Trengrove, modified by Dr Rob Lofstedt.
This drawing, by Dr Ronald Trengrove, a colleague and ex-teacher at Onderstepoort Veterinary institute, RSA, provides an excellent explanation of uterine prolapse in a cow. It is with his permission that it was provide for LORI. Dr Trengrove died in 2015.
When a cow has calved a large fetal-placental load (males, twins, hydrops etc) or secondary intertia follows dystocia, the myometrium lacks tone. The same occurs in cases of hypocalcemia. In both situations, the uterus may move caudally under the effect abdominal straining or gravity (when the cow lies in a pasture with her hind quarters downhill). As shown in figure a, involution occurs first, then, as the double wall of the uterus enters the birth canal (figure b), its bulk stimulates abdominal straining, expelling the uterus and completing the prolapse (figure c).
In most cases, neither the mesometrium nor its blood vessels rupture during prolapse. After cleaning and repair, the uterus can be returned to its normal situation by elevation, compression and pressure in a cranial direction. The value of topical osmotic agents such as magnesium sulphate and sugar is debatable. Once the uterus is in situ, a Buhner suture as used for vaginal prolapse can be applied to the vulva lips and both calcium and oxytocin can be administered to restore myometrial tone.
In the event that the uterus is severely damaged and cannot be replaced, a drastic salvage procedure was described by Dr Trengrove. The author has never attempted this and has not seen it described elsewhere. Using epidural anesthesia, the cow is made recumbent and the prolapsed uterus is hoisted over a plank (a). After using needle puncture or ultrasound to exclude the presence of the bladder, a major tourniquet (b) using Buhner tape is placed adjacent to the vulva lips. Then a split ligature of umbilical tape is placed more distally (c) and the uterus is transected along the length of the plank as shown. The stump is then replaced. Presumably analgesics and antibiotics are used to manage the cow so that she is able to recover and wean her calf.
Image size 469 x 446px
