POSTPARTUM DISEASES AND COMPLICATIONS - Part I: Uterine Prolapsedrvet Page 130April 11, 2020 [DRVET.IN]TOTAL UTERINE PROLAPSE - In Cattle and GoatsWhen the gravid horn following the expulsion of the fetus gets everted along with the non gravid horn and protrudes through the vulva it is referred to as post-parturient total uterine prolapse. Uterine prolapse is a common complication encountered in the cow, buffalo, sheep and goats during the third stage of labour. It is generally referred to as casting of wethers or casting of the calf bed. Most often it occurs immediately after parturition, occasionally up to several hours thereafter and in rare instances it may occur 48-72 h after parturition.INCIDENCE In cow, there is high occurrence of prolapse compared to other domestic animals. In bovine, it is observed in 0.5 % of all assisted dystocia cases. However, the condition occurs mostly in unassisted deliveries. Observed in 0.3-0.5% of all parturitions. Occurs in all age groups, but more in pluriparous and debilitated animals.ETIOLOGYNot clear, but it occurs during third stage of labour shortly after delivery of the calf. Predisposing factors Long and relaxed mesometrial attachments and lack of suspension of anterior portion of the gravid horn allows excessive mobility in longitudinal direction. Violent or strong tenesmus. Relaxed, atonic and flaccid uterus. Retention of placenta at the ovarian pole of the gravid horn in cows and non gravid horn in mares. Excessive relaxation of the pelvic and perineal regions. Dairy cows that calve after long confinement in stables with their rear quarter sloping downwards and hanging over the gutter. In the relief of dystocia, use of great force in forced traction of fetus predisposes to tenesmus. In dystocia, when the uterus is contracted tightly around the dry fetus, forced extraction is likely to result in prolapse. Most common in pluriparous cows. In poorly grown, thin debilitated dairy heifers. In milk fever, atonic uterus may prolapse due to increased abdominal pressure to labour. Low plane of nutrition.PATHOGENESIS During the process of fetal expulsion or immediately after delivery, an intussusceptionswhich begins at the ovarian end of the gravid horn gradually progresses posterior leading to the eversion of the mass. When abdominal straining begins, the mass suddenly gets prolapsed through the vulva. The gravitational force accelerates the intussusceptions and eversion in recumbent or standing animals with the hind quarters in an inclined plane. Subsequently, the stretching of the myometrium and uterine ligament leads to abdominal discomfort.drvet Page 131April 11, 2020 [DRVET.IN] Further the prolapse is accelerated due to straining as a result of the stimulation of receptor areas by the everted mass.CLINICAL SIGNS IN TOTAL UTERINE PROLAPSE Animal will be usually recumbent or standing with the prolapsed uterus hanging up to the level of the hocks. Retention of the placenta may also accompany the fetal membranes and/or mucous membrane of the uterus is exposed. Except in fresh cases, the prolapsed mass would usually be covered by dung, dirt, or blood clots. If the uterine prolapse exists for 4–6 h or longer, it will usually be enlarged and edematous In the cow, the gravid horn prolapses or everts sufficiently so that the cervix is usually seen at the vulva. Because of the strong intercornual ligaments, the non-gravid horn is held inside the peritoneal surfaces of the prolapsed gravid horn and does not evert. An oval or slit like orifice observed near the vulva on the ventral or lateral side of the prolapsed gravid horn is the opening of the non-gravid horn. In the doe, uterine prolapse is similar to that observed in the cow.PROGNOSIS Varies greatly. In most cases, Prognosis for the life: GOOD, If observed earlyprompt veterinary aid,o cow able to stand ando no severe injury of the uteruso  Future breeding: GOOD or POOR depending upon the severity of the uterine lesions, the promptness of treatment and the rate of involution. Prognosis is more GUARDED, Ifuterus grossly contaminated, oro dried due to exposure to sun, oro if lacerations are presento  Future breeding life: QUESTIONABLE - due to possibility of a septic metritis, perimetritis or peritonitis. It is surprising how much trauma, irritation, and contamination the uterus can withstand. After replacement of uterus this infection is overcome, the traumatic lesions heal, and the animal recovers. Prognosis: POOR to HOPELESSif animal is prostrate.o unable to rise ando o Conditions complicated by shock, internal hemorrhage, or incarceration of the intestines.Treatment:Treatment of expulsion of placenta is possible at three level, preventive approach before term, preventive approach after term and curative approach after placental retention.Prolapse of Uterus Treatment:Treatment of prolapse consists of three steps like reduction, reposition and retentiondrvet Page 132April 11, 2020 [DRVET.IN]1. 2. 3. Reduction: the prolapse mass needs to be reduced size with all efforts to reduce emphysema. It is possible to use ice cubes, application of herbal spray for reduction in mass size also cold water and hypertonic sugar solution, local application of oxytocin and adrenaline in uterine musculature can reduce size of prolapsed mass.Reposition: reposition necessitates applications of force on centre of prolapsed mass. it is necessary to lubricate prolapsed mass for facilitating reposition. Once centre of prolapsed mass is reposed, it’s possible to push the reminder peripheral part of prolapsed mass at site. As uterine contractions are going on continuously, many reposed parts prolapse within no time after reposition and care is necessary. While reposing the mass, no pressure should be applied with figure tips. Palm pressure is most suitable to repose prolapse mass starting from lateral walls, middle portion and roof of vagina.Retention: once prolapsed mass is properly reposed, it is possible to retain the same atappropriate site by reducing luminal diameter of birth canal . the best approach is to applying rope truss. It is recommended to prepare loose loop of only cotton rope to reduce vulval opening. Vulval opening is closed partially can be applied sutures after reposing of prolapsed mass. Use of vulval suture and negligence towards reproductive infection lead to forceful and violent contraction leading to rupture of suture and severe damages to vulvar portions.All prolapsed cases needs to appropriate managemental approaches after treatment which includes:1. 2. 3. 4. Provide laxative feed and fodderReduce abdominal load by overfeedingSupply fodder in divided partsContinue antibiotic and uterine tonic therapyGENERAL CONSIDERATION IN TREATMENT Instruct the farmer to keep the uterus of the animal moist and clean by either wrapping in a wet towel or sheet or place in a plastic bag until replaced. Until arrival of the veterinarian, the uterus in a standing animal should be raised and kept supported in level with the vulva. In recumbent animals, uterus should be supported and prevented from hanging. By doing so, edema formation in the uterus and possibly rupture of the uterine vessels can be prevented. Prompt and easy replacement is facilitated by proper restraint of the animal. Epidural anaesthesia should be administered in sufficient dose to provide good anaesthesia and at the same time keep the animal standing. In some recumbent animals that refuse to stand may rise up after administration of epidural anaesthesia. Further, it controls and prevents defecation during the process of reduction and repositioning of the uterus. In bovines, for certain types of obstetrical maneuvering it is advisable to have the animal standing and preferably with elevated rear quarters.METHODS TO ELEVATE REAR QUARTER OF THE ANIMAL An inclined platform is the most practical method to elevate the rear quarters of the cow.drvet Page 133April 11, 2020 [DRVET.IN] In recumbent animals, in order to elevate the hindquarters the following are employed:Sandbagso Straw stuffed bags, ando Inclined rampso  These improvised conventional methods have many disadvantages. PORTABLE BOVINE REAR QUARTER ELEVATOR DEVICEADVANTAGES It is very useful inReducing total uterine prolapseo Repulsion of fetus in dystocia, ando During intrauterine liquid replacer therapy.o  There is no stress to the animal due to the inclined posture. The device provides comfortable and effective working space for the obstetrician and can be used with advantage in veterinary institutions.