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Prolapse of the vagina and uterus

Prolapse of the vagina and uterus Theriogenology MT1 Dr. Estill 3rd year fall term OSU CVm
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Explain the process of vaginal prolapse in beef cattle.
most calving happens late winter early spring (cold) and then towards the end of gestation estrogen rises--> hyperemia and relaxation of the vulva and vestibule, so these animals lay down and its cold and vulva flops open bc so relaxed and then gets irritated from cold air--> causes straining-->push out vaginal tissue--> more exposed to cold--> more irritated, usually when stand up it goes in where it should be and edema subsides, but if the situation goes on it gets worse and worse and when reaches this point (right) it won't go back in and then gets compressed and lymph can't drain, straining all the time walks around w/ tail up and back arched up
When does vaginal prolapse usually occur?
Late gestation or postpartum
What causes vaginal prolapse prepartum?
High estrogen relaxes pelvic ligaments
What cows usually get prepartum vaginal prolapse?
Seen in older, fat cows
-may be hereditary in Polled Herefords
What is the seasonality of prepartum vaginal prolapse?
Occurs more often during winter
True or false. Vaginal prolapse predisposes cows to uterine prolapse.
False, does NOT predispose to uterine prolapse
What usually causes postpartum vaginal prolapse?
Usually related to dystocia
Why does vaginal prolapse tend to reoccur?
Hereditary
What 2 breeds commonly get cervicovaginal prolapse?
Santa Gertrudis
Beefmaster cattle
What can you do to correct mild cases of vaginal prolapse?
Clean with surgical soap
Coat edematous tissue and massage by into normal position
-may contain urinary bladder
What is the method of correction used for moderate/ severe cases of vaginal prolapse?
Replacement and retention performed standing under epidural anesthesia
What should you do to treat a vaginal prolapse if the urinary bladder is contained in the vaginal prolapse?
Stick needle in and decompress and massage and replace in pelvic canal
What can you do to allow urination in a cow with a vaginal prolapse that has the bladder reverted into the prolapse?
Lift dorsally to allow urination
What are 2 problem so fusing vulvar suture patterns to correct a prolapsed vagina?
1) if cow really strains she can tear them right out, so if placed place back into haired area not soft fleshy tissue of vulva
2) Calf can't get out so have to baby sit them till go into labor and remove sutures and deliver calf
What are 3 techniques used to correct cervicovaginal prolapse?
1) Bootlace
-Vertical mattress suture over some kind of stent
2) Buhner
3) Mencheve
4) Winkler Technique (Cervicopexy)
What is a buhner technique?
-Give cow epidural and make incision half way b/w anus and dorsal commisure of vulva and make incision in ventral commisure of vulva and then take buhner tape (can apply ointment to tape). Put one hand inside the vagina and then stick needle in ventral commisure and push forward towards the side so get lots of meet- pretty much put purse string around vulva- push it around till comes out the top incision
****What is the advantage of performing a mencheve repair of cervicovaginal prolapse?
Allows cow to calf unobserved
What is a Mencheve repair?
Use epidural, take spike inside vagina, feel cervix, go at 2 o'clock or 10 o'clock position and shove it right out through the gluteal muscles until skin is tented then make incision in skin (thick skin) and then take out the sharp thing and put button over the pin, pin had holes in it and can fix the button- adjustable to thickness of tissues, may want to even put 2 in them
***What is one of the most life threatening emergencies that can happen to a cow?
Uterine prolapse
-incidence < 1% of calvings
What causes uterine prolapse?
Cow continues an abdominal press on a flaccid uterus
-Dystocia, pelvic irritation, vaginal injury
-Hypocalcemia, inertia
-Uterus inverts and is forced out through the cervix
When do most uterine prolapses occur?
Most within first 24 hours after parturition
Which uterine horn tends to prolapse? What's the effects on the other horn?
Only the gravid horn (often subject to trauma)
-once uterus is prolapsed the tissues become edematous and friable
Why are uterine prolapses so life threatening?
-prone to vascular rupture and hemorrhage
-Abdominal viscera may strangulate in prolapse or the prolapse could rupture and eviscerate
What influences the prognosis of uterine prolapse?
Promptness of treatment
-handle ambulatory cows gently to avoid uterine trauma
What is the treatment for a prolapsed uterus?
-epidural
-clean w/ soap and water
-Remove attached placenta if possible (lose)
How do you want to position a cow if they have a prolapsed uterus and are recumbent?
Pull legs rearward to tilt pelvis
-elevate uterus during replacement
How do you replace a prolapsed uterus?
***Part that came out last goes in first
How do you straighten out the uterine horns when correcting a uterine prolapse? (3)
1) Infuse large amount (3 gal) of water + povidone iodine I.U.
-get cow to stand up and the weight of water causes horn to unintussuscept
2) Give oxytocin
3) Calcium borogluconate if needed
What is the prognosis of uterine prolapse?
If cow survives first 24-48 hours then prognosis is good
What is the prognosis of of uterine prolapse poor?
Cows with paresis, Stage III hypocalcemia, severe uterine trauma, shock or hemorrhage
Cows that survive a uterine prolapse are usually fertile but expect a ______.
Metritis episode
What happens if you correct a uterine prolapse but the uterus is not completely reverted?
Results in continued straining and re-prolapse
When should you use stitches after repairing a uterine prolapse?
If cow is recumbent and struggling put ina Buhner suture
-if sutured invagination of uterus on itself may go unnoticed so recheck in a day or so