Uterine prolapse in the cow Andrew White BVMS CertBR DBR GPCert(FAP) MRCVS 32 NEW LANE, PENWORTHA PENWORTHAM, M, PRESTON. PR1 9JJ
The call from a farmer to replace a prolapsed uterus into a newly newly calved cow cow (Fig. (Fig. 1) is one of those occasional tasks which the veterinary surgeon in practice is asked to carry out. Often the veterinary surgeon on duty who is asked to attend the case will not have seen many cases themselves nor will they have been actually shown how this task should be carried out.This 8 vet practice has only been called to replace 31 prolapses in the the past 12 months. months. It is therefore understandable understandable that the task ahead is faced with some trepidation. trepidation. It is usually at an unsociable unsociable hour and the farmer is often not very familiar with the procedure. procedure. Coupled with that is the fact that in this modern world there is usually an acute lack of manpower manpow er available on farm. The replacement of a prolapsed uterus is one of those scenarios where a text book article or college lecture notes can make the task seem very straightforward but the reality is completely different!
Fig. 1: Newly calved cow with prolapsed uterus.
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This article illustrates how the replacement can be achieved quickly and safely (for the patient and personnel personn el alike), alike), with little deman demand d for farm manpower. manpow er. This practice adopted this technique as our standard at least 30 years ago and have found it to be very very successful. In adopting this technique, technique, basically advocated in the literature more than 20 years ago now (Johnson (Johnson,, Ly Lyons ons and Plenderlieth 1986) our principal concerns were, were, and still remain, the welfare of the cow, cow, the welfare of the veterinary surgeon and the best use of equipment and available available personnel on farm. The replacement of a fully prolapsed uterus in a cow places considera considerable ble stress stress on the animal. animal. The inevitable straining which occurs during replacement can be controlled to some extent by the use of epidural anaesthesia, anaesthesia, but the very very removal removal of this push by the cow cow also remo remove vess the relaxatio relaxation n phase which can be utilised to advantage during the replacement procedure procedure.. Unless the uterus is very very recently prolapsed, it becomes swollen and hardened hardened as well as friable, making replacement replacement more difficult. The fluid can be drawn drawn out of the uterus by the use of sugar,acting sugar, acting by osmosis,but osmosis, but this all adds to the time required for replacement and to the stress of the cow. As our cows get bigger, and some vets get smaller (!) so the sheer sheer physical physical effort required to present the prolapsed mass back to the vulval lips of the cow increases. Often there there are not sufficient sufficient farm staff availab av ailable le to help to to support support the uterus uterus whilst whilst replacement is attempted.The effects of gravity and the size of the cow cow combined to encourage encourage us to look at alternative alternative methods of replacement. To this end it has been suggested that the cows cows be cast, if not already recumbent, recumbent, and the rear end either raised on
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a bale of straw (Formston 1986) or that the cow be placed in sternal recumbency and the rear legs extended backwards. Both of these require a considerable labour force to achieve.
(Fig. 3) and tightened proximal to the joint.The two belts, linked by a short rope, are attached to a fore end lift of a tractor and raised until the vulva of the cow is about one metre from the ground (Fig. 4).
TECHNIQUE The method which we have adopted consists of raising the rear end of the cow to a height of about one metre using a fore end loading tractor. The uterus can then be cleaned, and replaced quite simply by gently holding it up to the vulval lips and allowing gravity to do most of the work of drawing it back into the cow.All the vet has to do is to ensure that there is no rotation of the uterus, thus preventing its replacement.
(The safety of working underneath the raised foreend loader must be considered. This will obviously depend on an assessment of the mechanical soundness of that machine. If there is any doubt whatsoever that the lift will not stay raised, then the arms of the lift must be supported by wooden props.)
In this position, it is a simple matter to wash off the uterus, usually by immersion into a bucket of lukewarm water (Fig. 5).The prolapsed uterus is then simply raised above the vulva (Fig. 6) and, with only
Most cows with a prolapsed uterus are recumbent when approached and it is important to keep her down during the preparation process. The cow is best rolled over into lateral recumbency and then any remaining afterbirth can be gently detached.Two wide belts (Fig.2), such as those used in a foot paring crush, can easily be looped over the hock joints
Fig. 5: The uterus is washed clean. Fig. 2: The straps which are used.
Fig. 3: Straps are placed above both hocks.
Fig. 6: The uterus is held above the level of the vulval lips.
Fig. 4: The rear end of the cow is gently raised.
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minimal help and guidance,to ensure that there is no rotation of the uterus and thus no uterine torsion, the uterus slips back remarkably easily (Fig. 7). Once returned to the inside of the cow, it is a simple matter to feel into the vagina to ensure complete repositioning of the uterus through the cervix (Fig. 8). In this practice, we always suture the vulval lips together after replacement (Fig. 9).
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calcium solution. Only when the afterbirth has not come away completely, or the uterus has been prolapsed for a long time, do we give antibiotic cover.
Fig. 7: The prolapse is guided in.
Fig. 10: The cow regains her feet.
Fig. 8: The uterus is completely returned through the cervix.
We have found this to be a quick, easy and essentially practical method of dealing with a prolapsed uterus and would recommend it to others. We are aware that some of our veterinary schools and individuals (Parker 1986) regard the raising up of a cow to be welfare unfriendly but, provided the hoisting rope is a strap at least 2" wide we do not feel this is the case. We have no evidence of damage to the muscular skeletal system as a result of the hoist. During the procedure illustrated in this case, the cow was suspended for only six minutes and the whole procedure from approaching the case to the cow standing up with uterus replaced, took 25 minutes. The physical effort required of the vet was minimal, and the cow stood up immediately after the procedure. REFERENCES FORMSTON, C. (1986) Uterine prolapse in the cow. Veterinary Record 118 p. 492. JOHNSON, R. W. (1986) Uterine prolapse in the cow. Veterinary Record 118 p. 252. LYONS, A. R. (1986) Uterine prolapse in t he cow Veterinary Record 118 p. 492.
Fig. 9: The vulval lips are sutured.
PARKER, C. D. (1986) Uterine prolapse in the cow Veterinary Record 118 p. 310. PLENDERLIETH, R. 1986 Uterine prolapse in the cow In Practice Vol 8 p14.
(For this purpose, I use Finlayson thread to place two loops horizontally across the vulval lips. This material is very strong but also quite thin in diameter and thus will tear through the tissues unless a thicker material such as tape or thick twine is used as an anchor point at each end of the horizontal sutures.)
I am not convinced that this is entirely necessary, but it seems to be tempting fate not to do so.We leave the sutures in situ for 72 hours. After replacing the uterus and lowering the cow to the ground (Fig. 10), because of the associated link between prolapse and hypocalcaemia, we also administer a full bottle of a
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