I was on call this past weekend and had quite an array of
calls. The first was for a left DA; pretty routine procedure that went well. The
second call was for a weak goat that, after performing a fecal, was found to be
loaded with intestinal parasites (worms). He was treated with electrolytes, dewormed
and sent home. Hopefully he had not lost so many nutrients and blood from the worms
that he is able to recover after a couple rounds of dewormer. The next call was for a cow that had calved
earlier that day and suffered from a uterine prolapse. The final call of the weekend was a calving.
I know I’ve discussed other emergency calls where I’ve had
to attend to a prolapse, but never had any pictures to show you what it really is. When I arrived at this farm, the cow was out in
the pasture and I had to have them run back to the barn to get water, so I had
some time to actually take a picture!
Uterine prolapses are one of the few TRUE, emergency- drop-
everything -and – come calls that we get in dairy practice. This condition
usually occurs in older cows that have already had one or two calves. It can
happen in first time mothers, but is not quite as common. Normally prolapses will occur within the
first 24 hours after a cow has had a calf. If she has made it through the first
24 hours without any trouble, it is pretty rare that she will prolapse at that
point.
For those that have never seen a uterine prolapse, it is
when the entire uterus, which I remind you just had an 80+ pound calf inside
it, completely inverts and falls outside of the vagina. It is the uterus,
inside out, outside the cow. Sometimes the bladder will also come out with it,
and in really bad cases, there may be some loops of intestines that also have
prolapsed.
In the picture you
can see these large “lumps” on the uterus.
These lumps are called the “caruncles” and are the attachment points of
the placenta (cotyledons) for the calf. The best analogy I can come up with for a uterine prolapse, is a pair
of pants that you have taken off, and instead of grabbing the ankle and pulling, you start
at the waist and completely turn them inside out.
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| Prolapsed uterus |
There is no definitive “cause” of a uterine prolapse; however
there are certain conditions that predispose cows to prolapse. A difficult calving where the cow strains a
great deal, continues to strain and/or has a very large calf, will predispose a
cow to having the uterus prolapse, as well as when the cow is hypocalcemic (low blood calcium). Calcium plays a role in smooth muscle
contractions in the body. The uterus is considered a “smooth muscle” organ, so
when the cow is low on calcium in her blood, the uterus is not contracting down
like it should, after the cow has calved.
Some of the biggest concerns we have about cows with a
uterine prolapse is shock due to blood loss, traumatic damage to the uterus as
it is outside the cows’ body, and entrapment of the intestines in the
inside-out uterus, causing an entirely different issue. The uterus is suspended in the cow from two
ligaments that attach to the side if the body. Inside each of these ligaments
is a major vein and artery. As the
uterus is prolapsing, turning inside out, headed out of the vagina, it
stretches these ligaments and therefore the veins and arteries inside them. The concern is when they have been stretched
to the point that they have ripped and as tension is released on these vessels, the cow starts bleeding internally
and can easily bleed to death in a short time.
So how do we take care of this 50+ pound organ that is
supposed to be inside the cow that is now outside??? Well, first and foremost
we give the cow an epidural, or spinal, to prevent her from feeling the
procedure and also to prevent her from continuing to push and strain against us
as we try to replace the uterus. The cow
can be standing while we fix her, or can be laying down with both back legs extended
directly behind her. We then wash the uterus being sure to remove as much
bedding, mud, debris, etc. from the uterus as possible.
Now back to the pant analogy. We can fix the pants by going
from the waistband, back down the leg, grab the cuff and pull it back up through.
Well in a cow, we can’t jump inside the cow, and reach from the inside to the
tip of the uterus and pull it back through. Instead, we have to start gently
pushing the uterus back in, starting close to the vulva and working it back
inside. It would be like starting with the cuff of the pants and pushing it
back through to the waistband.
As we are pushing the uterus back, we have to be sure not to
rip off any caruncles, or push our fingers through the sensitive and damaged
uterine tissue. If a tear does occur,
then we can suture the hole and continue on. It’s just better if we avoid
making a hole in the first place.
Replacing the uterus is quite a workout, if I do say so, but
I can replace a nice “easy” prolapse in about 20 minutes. I have also worked on them for over an hour only to have the cow push it back out just as I have it almost all the way in. The longer the
uterus is prolapsed, the more edema the uterus will get, it can dry out and
become less pliable and can be severely injured from other cows or herself. When a cow does have a uterine prolapse, we
recommend the farmer keep her quiet, keep other cows away from her, and try to
keep the uterus as clean and moist as possible until we can get there.
After the uterus has been pushed back inside the body, we
have to make sure it is completely everted so it doesn’t re-prolapse. We then
give the cow an injection to help with the smooth muscle contraction and shrinking
the uterus back down so it can’t come back out. Finally we give the cow some calcium in the
jugular vein and start her on antibiotics in case we didn’t get every little
spec of dirt off the uterus before we replaced it.
Some practitioners will place a “buhner stitch” in the cow’s
vulva after replacing the uterus. It is
a stitch that essentially closes the vulva up and allows only enough room for
her to urinate. As a practice we have decided to do this, but it really is more
of a placebo effect for the farmer. If
the uterus was replaced properly, and the cow was given the appropriate
medication to start the uterus shrinking back down, there is no need for this
stitch. If the uterus was not replaced
correctly and the cow continues to strain, or the medications were not given to
start the uterus shrinking back down, she can re-prolapse and this stitch will
do nothing to stop it. For the cows that
do have a buhner stitch placed, it is removed about 4-5 days later. The picture shows the stitch placed after I
replaced the uterus on this cow.
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| Buhner Stitch Placed |
This cow stood during the entire procedure and walked to
another part of the pasture and started eating when we were done. I think she will be fine and should breed
back in a few months with no issues.
