Bovine Prolapsed Uterus

Also known as

Uterine prolapse

Description

Prolapsed uterus usually occurs within a few minutes to a few hours after calving, while the cow’s cervix is still dilated. If she keeps straining because of continued contractions and after-pains, she may push the uterus on out, and this can happen whether the birth was easy or difficult. The far end of one or both uterine horns may begin to turn inside itself, which creates something to push against. It keeps inverting and is pushed out through the birth canal.  

This forty-plus pound mass of fragile tissue hanging out of the cow can be a life-threatening situation unless the uterus is replaced quickly. If weather is cold, the exposed uterus is an outlet for loss of body heat; the cow may chill or go into shock and die.

If she happens to lie on, step on, or kick the uterine tissue hanging down past her hocks, she may rupture a major artery and quickly bleed to death.

During pregnancy the uterus has a large blood supply to take care of the developing fetus, and these large arteries may be nearly the size of a garden hose. When the uterus turns inside out, these arteries are on the inside surface of this large organ. With the uterus hanging out, a lot of strain and tension is placed on these large uterine vessels.

This puts them at risk of rupturing, which can cause the cow to go into shock and bleed out internally. Running the cow around to get her into a corral, or transporting her to the vet is not recommended, as this can cause more trauma and tension to the uterus and its associated vessels.

If an artery ruptures, the cow may bleed to death within 5 to 10 minutes. The inverted uterus is easily bruised, and will become infected if the cow is lying on the ground or if it becomes covered with manure.

Prolapse of the uterus should not be confused with prolapse of the vagina (a condition which usually occurs before calving, in a heavily pregnant cow). The vaginal prolapse is a pink mass of tissue about the size of a large grapefruit or even a volleyball, whereas the inverted uterus is a much larger, longer mass, more deep red, and covered with “buttons”—the deep red caruncles--to which the cotyledons of the placenta were attached. These “buttons” range from coin size to fist size.

Signs

• Emergence dark-red uterus from birth canal after calving
• Prolapsed organ usually hangs down below the hocks

Causes

Some of the things that are blamed for uterine prolapse include difficult birth, lack of exercise and too fat, or retained placenta, but these situations occur many, many times without causing uterine prolapse. Sometimes there may be an underlying cause such as mineral imbalance--such as low calcium.

It’s generally a one-time event for that cow and there is no reason to not keep her in the breeding herd if she rebreeds on schedule, since she is very unlikely do prolapse again.

Prevention

If a birth must be assisted and you have to pull the calf, to lessen the likelihood of uterine prolapse, get the cow up as soon as possible afterward. Getting her up and moving around will usually help the uterus drop back down into the abdominal cavity and straighten the uterine horns. Without a partially inverted horn against which to strain, it is difficult for a cow to prolapse.

Make sure pregnant cows are on a balanced diet with adequate minerals such as calcium. Cows should not be too thin or too fat at calving.

Treatment

A prolapsed uterus is always a serious emergency. The earlier you detect the problem, the better. Then the prolapsed organ is still clean, less likely to be infected, and much easier to put back in, compared to trying to deal with it hours later or a day later. It’s also easier on the cow if you can replace the uterus quickly, rather than after it’s dirty, and possibly bruised and damaged.

Your veterinarian should be called as soon as the condition is discovered, unless you are experienced at putting this organ back in. The veterinarian will probably give the cow an injection of local anesthetic when he begins the task of cleaning up and replacing the inverted organ. This will keep her from straining and pushing against the replacement efforts. The uterus must be thoroughly cleaned and washed, and put back in.

If possible, the cow should be moved into a sheltered area with clean dry ground or good bedding, with good footing. You will need ropes, hobbles and a halter, to restrain the cow. Very few producers try to replace the uterus themselves; it’s challenging without the benefit of an epidural injection to diminish the cow’s straining.

Positioning the cow correctly is also helpful for replacing a prolapsed uterus. If her front end is downhill (so you aren’t fighting gravity) this will help. One method is to use ropes to put the cow on the ground so that she is lying on her breastbone and belly, then pull her hind legs back behind her so she’s frog-legged to tilt the pelvis up.

At that angle she isn’t as able to keep pushing the uterus back out again as you work on it, with gravity in your favor.

Have a large plastic garbage bag on hand, to put underneath the uterus while cleaning and washing it, to keep straw or dirt away from it. You can drape the uterus in the large garbage bag. You also need plenty of warm water, and some mild soap or disinfectant to help with cleaning the uterus.

A tripod of poles can also be created (like a teepee) above the cow to provide a framework for a pulley, to raise her hind end higher than her front.

The veterinarian will give the cow an epidural, and usually an anti-inflammatory drug such as flunixen meglumine (Banamine). Many veterinarians also give an antibiotic, since the uterus is likely to be contaminated.

The longer the uterus is out, the more edema (swelling) builds up in the tissues. This makes it more difficult to replace. One thing that works to reduce edema is to apply sugar to the surface. This works as an osmotic agent to pull fluid out of the tissues and help shrink them as you are pushing the uterus back in. The high concentration of sugar on the tissue surfaces also has some antibacterial properties.

You work and work at it, trying to squeeze edema out of the tissues and push the uterus back through the pelvic canal, then gradually it starts to go back in and you are able to replace it.

One of the most crucial factors to ensure that the uterus stays in is to extend both horns fully to their proper position. If even a small tip of horn is still inside out, this gives the cow something to push against and she may push the uterus right back out again if she strains.

Sometimes it can be difficult to reach that far into a long uterine horn. One thing that can help is a clean wine bottle to extend your reach. Some veterinarians instill an antibiotic into the uterus, but many don’t.

If there’s a chance that the cow is low on calcium, the veterinarian will also treat her with calcium. This increases uterine tone and helps minimize the chance of prolapsing again. Oxytocin can also be administered to help improve uterine tone once the uterus is replaced.

The next step is to keep the cow from pushing it right back out again.  The vet may give the cow another injection of local anesthetic afterward to keep her from straining, or put a few sutures across the vaginal opening to keep the organ from being pushed out again, until the cervix has contracted and there is no danger of recurrence. The stitches can be removed in a few days.

If the uterus is not out very long, and is kept clean and undamaged until it can be replaced, the cow generally recovers. Most cows that prolapse will rebreed, and have no problems with the next calving. Repetition of this condition is rare.

Whenever a uterus prolapses, however, there is always some risk for damage to the uterine arteries. If a uterine artery ruptures or tears, the cow bleeds internally--where the artery comes from the aorta and connects to the uterus. It’s not bleeding into the uterus, but into the abdominal cavity.

Sometimes the artery is stretched and starts bleeding again once the uterus has been replaced. Many of the deaths that occur after replacing the uterus are due to a ruptured uterine artery, and there’s nothing you can do for this.

Some prolapses are followed in an hour or so by death of the cow, due to internal bleeding.  The weight of the uterus hanging down can tear some of the tissues, rupturing major arteries.  But in most cases, even when there has been bruising and contamination, the uterus will heal and the cow will fully recover.

In some instances it is not practical or feasible to replace the uterus, if it is severely damaged. In these cases the best option might be to amputate the uterus, to save the cow.

There are surgical methods, and some banding methods, similar to banding for castration. Both methods work. Banding tends to be easier and quicker, with similar results to surgical amputation. Removing the damaged uterus might be an option, rather than just butchering the cow, so that she can raise her calf and then be sold.