Prolapses

Question 1

True or False: Prolapses occur in all species and management is similar between all species

Answer 1

TRUE

Question 2

At what time does a uterine prolpase most commonly occur in cows?

Answer 2

12-24 hours after calving

Question 3

True or False: A uterine prolpase in a cow is a life-threatening emergency

Answer 3

True. The prolapsed uterus is tugging on all the blood vessels inside the body so try to avoid moving the animal

Question 4

What is the prognosis for uterine prolapse if treated early?

Answer 4

80% survivalrate with alow reoccurrence rate(if done properly the first time)

Question 5

What percent of cows have future fertility concerns if they’ve had a uterine prolapse?

Answer 5

33-85%

Question 6

What is the average incidence of uterine prolapse in cows?

Answer 6

< 1%

Question 7

What anatomical factors lead to a uterine prolapse?

Answer 7

Decreased myometrial tone and open cervix (caused by hypocalcemia and dystocia

Question 8

List five risk factors for a uterine prolapse

Answer 8

1. Calf extraction method (calf pullers)
2. Increased parity (multiparous > primiparous)
3. Tenesmus
4. Low BCS
5. Concurrent metabolic disorder (ex. hypocalcemia)
   Dairy cows are also at a higher risk than beef cows

Question 9

True or False: Uterine prolapses are highly heritable

Answer 9

False, there is low/no heritability factor

Question 10

What is the farmer term for uterine prolapse?

Answer 10

“Calf bed”

Question 11

How can you tell if a cow has a uterine versus a vaginal prolapse based on a history over the phone?

Answer 11

If it’s a uterine prolapse:
- Endometrium caruncles +/- fetal membranes and exposed endometrium
- Cow may be in shock or have signs of hypocalcemia
- May contain intestines/bladder
- External bleeding from placentomes
Ask the farmer:
- Is it a large structure with bumps or a small round structure?
- Is there lots of blood?

Question 12

True or False: Hypocalcemia should be treated before putting a prolapse back

Answer 12

False. Calcium induces contraction of tissue, so it will make it a lot harder to put a prolapse back.

Question 13

What should be monitored while fixing a uterine prolapse?

Answer 13

• Contamination
  -Edema
• Cervical closure (will occur if you take too long)
• Uterine artery rupture (possible if you move or hoist the cow)

Question 14

What position is ideal to fix a uterine prolapse?

Answer 14

Keep the cow standing. If she is recumbent, get her in sternal recumbency at least so you can use gravity to help you

Question 15

What is the main risk of hoisting the hind quarters of a cow to fix a uterine prolapse?

Answer 15

Risk of MSK injury/uterine artery rupture (gravity)

Question 16

What are the eight steps to managing a uterine prolapse?

Answer 16

1. Standing is ideal butif down, put in sternal recumbency
2. Cast and tie legs back
3. Chemical restraint (ketamine stun/xylazine and caudal local epidural to reduce straining)
4. Evaluate cow for shock and/or hypocalcemia
5. Remove placenta and lavage until relatively clean (water or hypertonic saline)
6. Evaluate tissue and contents
7. Attempt to keep uterus elevated to restore perfusion
8. Push slowly starting from closest to the vagina/base (as if you’re kneading dough - avoid using fingers) to apex
9. Ensure a complete inversion and infuse with warm water/dilute iodine
10. Give oxytocin (only once corrected)
11. Give analgesics and antibiotics
    Be patient! You likely only have one chance to fix it

Question 17

Why should oxytocin only be administered after the correction of a uterine prolapse?

Answer 17

Using it beforehand will increase the risk of iatrogenic perforation and makes it way harder to put the uterus back in

Question 18

What type of anesthesia can be used to reduce straining in a cow with a uterine prolapse

Answer 18

Caudal epidural

Question 19

How can you prevent the reoccurence of a uterine prolapse?

Answer 19

• Treat uterine atony
• Use Buhner’s suture
  It’s rare that it will happen again if it was properly fixed

Question 20

What are the potential complications of a uterine prolapse (six)?

Answer 20

• Hemorrhage (due to uterine artery rupture)
• Peritonitis
• Metritis
• Re-prolapse/unsuccessful reduction
• Uterine tears
• Damage to other organs

Question 21

When is a uterine amputation indicated?

Answer 21

If you waited too long and the cervix has closed (can’t get the uterus back in). Do a salvage procedure and ligate uterus with umbilical tape and IV tubing. Poor prognosis so get her to raise the calf then slaughter.

Question 22

What are the pre-partum risk factors for a vaginal prolapse (six)?

Answer 22

• Pelvic injury (causes pelvic laxity)
• In last trimester or dry period (dairy cattle)
• Increased intra-abdominal pressure
• Lying downhill (sheep and free stalls)
• Excessive straining/irritation
• High BCS

Question 23

What are the post-partum risk factors for a vaginal prolapse (six)?

Answer 23

• Diet (poor quality forage)
• Hypocalcemia
• Estrogenic influence of late gestation (mycotoxin (zearalenone), implants, ovarian cysts, super-ovulation)
• History of multiple super-ovulation procedures
• Breed predispositions (brahma, hereford)
• High BCS

Question 24

What are the common contents of a vaginal prolapse?

Answer 24

Vagina, cervix, bladder, intestines

Question 25

True or False: Vaginal prolapses are highly heritable

Answer 25

True. These are highly heritable and have high reoccurrence rates (often culled after weaning because of this)

Question 25

What are the clinical signs of a vaginal prolapse?

Answer 25

- Tenesmus - Protrusion of pink/reddened mucosa - Edema

Question 26

What is the average incidence of vaginal prolapse in cows?

Answer 26

< 2%

Question 27

What are four causes of a vaginal prolapse in a peri-parturient or non-pregnant cow?

Answer 27

- Ovarian cysts - Toxins in diet (mycotoxins if a herd issue or phytoestrogens) - History of dystocia - History of pelvic injury/innervation

Question 28

How can you grade a vaginal prolapse?

Answer 28

Grade 1: Intermittent prolapse of vagina Grade 2: Continuous prolapse of vagina +/- bladder Grade 3: Continuous prolapse of vagina, bladder, and cervix Grade 4: Grade 2 or 3 + trauma, infection, or necrosis of vaginal wall

Question 29

How can you treat a vaginal prolapse?

Answer 29

Essentially the same way you fix a uterine prolapse but here are some differences: - May resolve when standing (can leave it and just observe if cow is close to calving) - Change environment if mild prolapse (change to well-bedded pack where hindquarters are not dependant) - Can use Buhner suture but you must remove this before they calve

Question 30

How can you reduce edema in a uterine or vaginal prolapse?

Answer 30

A sugar or calf electrolyte powder enema

Question 31

How can you maintain the reduction of a vaginal prolapse?

Answer 31

- Buhner suture (remove before birth!) - Analgesics are likely enough, may not need antibiotics *Method depends on stage of pregnancy*

Question 32

What are the three types of suture techniques for reduction of a vaginal prolapse?

Answer 32

- Buhner's - Barth Blowout - Shoelace technique

Question 33

Name six differences between a vaginal and uterine prolapse

Answer 33

- Uterine prolapses are larger than vaginal prolapses - Vaginal prolapse occurs mostly pre-partum and uterine prolapse occurs mostly post-partum - Vaginal prolapse is highly heritable (culling recommended) - Vaginal prolapse is not necessarily an emergency, but a uterine prolapse is - Uterine prolapse cows should not be moved and vaginal prolapse cows can be if needed - Vaginal prolapse requires sutures but with a uterine prolapse it's more optional

Question 33

What are the complications of a vaginal prolapse?

Answer 33

- Sutures tearing out (common when producers fix themselves without an epidural) - Suture site infection - Iatrogenic (forgot to remove suture - causes dystocia if forgotten in pre-partum cattle)

Question 34

Why are rectal prolapses more common in younger animals (especially small ruminants)?

Answer 34

Because they more commonly have diarrhea and tenesmus, which leads to increased rectal pressure

Question 35

What are the two types of rectal prolapses?

Answer 35

1. Partial/incomplete (mucosa everts beyond the anus but might go back in) 2. Complete (full thickness layer of the rectum is protruded)

Question 36

What is the most common complication of a rectal prolapse?

Answer 36

Adhesion development (prevents manual reduction of the prolapse)

Question 37

How can you grade a rectal prolapse?

Answer 37

Grade 1: Prolapse of rectal mucosa only Grade 2: Complete prolapse of all layers of rectum Grade 3: Complete prolapse of all layers of rectum andlarge colon Grade 4: Complete prolapse of all layers of rectum, large colon, and an intact anal sphincter that causes rectal constriction

Question 38

How do you treat rectal prolapses based on the grade?

Answer 38

Grade 1: Diet modification + medical management and digital reduction (70% success rate) Grades 1 + 2: Fixed by reduction and retention with purse-string suture (33% success rate) Grades 3 and 4: Requires surgical resection or amputation

Question 39

True or False: Rectal prolapses are highly heritable

Answer 39

False (but it can have a high reoccurrence rate if you don't correct the primary problem, such as diarrhea)

Question 40

How can you reduce a rectal prolapse with viable mucosa?

Answer 40

1. Manual reduction using epidural and lubrication 2. Purse string suture (umbilical tape + serpentine needle) and leave for 5-10 days (leave small opening for defecation) 3. Follow up with a softer diet so it doesn't re-occur

Question 41

True or False: Glycerine can be used in the treatment of rectal prolapses as an osmotic agent and lubricant

Answer 41

TRUE

Question 42

How can you treat a rectal prolapse with non-viable mucosa?

Answer 42

- Mucosal resection (rarely done) - Surgical amputation

Question 43

What are the two ways of performing a rectal amputation?

Answer 43

1. 4 pin method, then remove pins/tubing and reduce rectum (don't forget about analgesia but you likely don't need antibiotics) 2. Rectal prolapse tube (can be done by farmer - but does require antibiotics because it causes necrosis - don't use this strategy if at all possible)

Question 44

What are the most common complications with a rectal prolapse?

Answer 44

- Recurrence (especially if you do not fix original diet issue) - Constipation - Dehiscence - Prolapse of other organs - Abscess - Peritonitis - Fecal impaction and death (more common with the use of prolapse tubes)