Uterine prolapse in a cow

Re: Uterine prolapse in a cow

Michael Woodhouse — Wed, 24 Apr 2013 13:19:54 GMT

I do always stitch ewes. Can't give a good reason other than stitching possibly 20:1 vaginal prolapses back.

I use a funnel and half a bucket of water to ensure the horns are inverted fully. Sheep held up by back legs.

Touch wood - never had one come back out in a sheep.

Re: Uterine prolapse in a cow

scatty — Wed, 24 Apr 2013 12:03:39 GMT

I am assuming that people don't stich on a ewe either? Had a ewe which pushed her uterine prolapse out again about an hour or so after replacement this morning. That was after epidural, calcium, rimadyl, oxytocin - the lot. Frustrating! A wine bottle not so appropriate for a sheep!

Re: Uterine prolapse in a cow

Braden Collins — Wed, 24 Apr 2013 00:45:01 GMT

My baisc tips - if you have enough assistants, put the uterus on a thick bit of plastic and get them to hold it up above the vulva. Or if you have a calving gown they can hold the corners of that up with the uterus on it, but it means you get a lot of pressure on the shoulders.

Recurrence tends to be because the uterus is not fully everted. I found a long neck wine botte gave me the extra reach I needed to push it all the way out (and an excuse for a drink)

I never stitch as they will just tear the stitch if they push it out again.

Re: Uterine prolapse in a cow

macflea — Tue, 23 Apr 2013 23:50:40 GMT

done a few lately, patience is needed, plenty of salt and sugar and they will go in, never failed, wouldn't even consider amputation, if standing great , if down i am too lazy to make the effort , i tend to use a hoist (hip lifters), if i don't have one or if farmer doesn't have one , i swear a lot in silence and tie them by the back legs and get the farmer to lift her with the loader , always goes back in , once backside higher than head. if suckler is down and cross i give them a good sedation, never had any problems . i avoid stitching straight throught the lips cause in my experiance they strain a lot after this, irritation of vaginal epithelium, i stitch from outside creating an inverted stitch of the lips . once i get uterus clean enough i am happy enough, once back in put in pessaries and even pour in a bottle of penstrep to leave it pool in uterus , i avoid any iodine disinfection of uterus as i reckon it will cause lining of uterus to flare up making things worse, i think salt wash and pessaries and plenty of pen strep should settle it , no matter how dirty.

Re: Uterine prolapse in a cow

mariette asselbergs — Tue, 23 Apr 2013 23:10:17 GMT

What, put her finger through, the cow? Or was this a female farmer?

Mariette

Re: Uterine prolapse in a cow

Michael Woodhouse — Tue, 23 Apr 2013 23:04:47 GMT

[quote user="mariette asselbergs"]If the cow dies on day 3, Michael, I would suspect that there was an undetected tear?[/quote]

So would I, but I am 100% sure I didn't put a finger through. Suppose she could have done it herself?

Re: Uterine prolapse in a cow

mariette asselbergs — Tue, 23 Apr 2013 23:00:08 GMT

Sorry, the tray is made of a mash, not a lash

Mariette

Re: Uterine prolapse in a cow

mariette asselbergs — Tue, 23 Apr 2013 22:59:19 GMT

Yes I have had two cows die white as a sheet too, and agree with Julian that this is a torn ligamental or ovarian artery..

In Germany they sell a sort of tray made of a lash which is hugely helpful in keeping the uterus in total lifted up, out of the muck and higher than the vulva. Either in the standing or the lying down cow this helps immensely to let it "slide in" (with some physical effort admittedly but at least Newton's gravity helps).

If the cow dies on day 3, Michael, I would suspect that there was an undetected tear?

Mariette

Re: Uterine prolapse in a cow

Michael Woodhouse — Tue, 23 Apr 2013 22:38:29 GMT

[quote user="Michael Woodhouse"]There was an article in UK Vet I'm guessing ~4 years ago using a technique where you hobble the back legs and lift the rear of the cow with a loader. I've never tried it but it is filed in the back of my mind should I need it one day.[/quote]

Well that day finally came!

Had a nurse appointment at 5.00pm so prolapsed uterus call comes in at 4.10. Hope I can get it in quickly, as on the way (ish) to doctors.

Cow got up and gave epidural, as soon as you handled uterus she flopped down. Then tried to get back up. etc etc.

Decided to do her down - she kept fighting frog sitting position and me and big farmer couldn't get both legs out behind at the same time. No other labour.

Got him to fetch loader - tied legs to loader - lifted back end. Back in in literally 2 minutes. Almost perfectly inverted itself. Cow did fine.

Made it to doctors 5.10 bloody and a little sweaty.

Would use the technique again in difficult cases

(did have one die recently that was so textbook - standing and less than 5 minutes pushing. 100% sure not torn. Cow reported as fine the day after. Died day 3?)

Re: Uterine prolapse in a cow

Julian Earl — Tue, 23 Apr 2013 19:30:42 GMT

[quote user="Hannah Wynne Richards"]

Micheal is either very good or very strong I'd say 20/30 mins average was more realistic

Wynne

[/quote]

The key is all in the preparation. If the cow is in the frog positiion then it is all alot easier because they cannot strain as efectively. Likewise, the first thin I do is give calcium, then an epidural. Antibiotics and NSAIDs post-procedure as well. I use clenched hands, and box the edges of the prolapse back, whereas using flat hands and fingertips makes it more likely to push your hand through [always suture those].

The other thing not mentioned yet is the importance of getting to them early,ie fast. Too long and the uterus swells and becomes firm oedematous and rubbery. when fresh it is vastly vastly easier to feed a floppy uterus back through the pelvic canal. Firm and rubbery is the effect of oxytocin as well so I never use that until it is back inside. If left too long that is when salt or sugar becomes useful.

I don't suture either, to the disgust of some farmers who have seen them stitched before. But I was lead to believe that if a cow wants to shove it out again it is because the uterus has not been properly re-inverted, and a buhner suture won't stop it.

BTW. I've had two die in the procedure in both cases they went white as a sheet, or as a cow bleeding massively internally, then swayed and keeled over. Inone case I'd only just started and the cow was down anyway as I was giving the calcium "what was in that bottle?" asked the farmer. He wasn't convinced by the white mucous membranes that I pointed out. My belief is that the ovarian artery iwll only stretch so far, and TWANG is curtains for the cow.

Re: Uterine prolapse in a cow

Michael Woodhouse — Thu, 22 Nov 2012 18:30:06 GMT

BB - it's a nice feeling - isn't it?

If you get the farmer to straddle the cow so he's sitting on the cow's pelvis facing you, holding the tail upwards at 90°, that stops the cow trying to rise and keeps the tail out of your way.

Re: Uterine prolapse in a cow

Busybee — Thu, 22 Nov 2012 18:25:37 GMT

Well, had a successful one early this morning! (5am instead of 3am, slight improvement, though I'd already had an acute pancreatitis at 1am!) Did call my boss to help as no help on farm, but he just watched and offered moral support. Got cow in frog leg, epidural placed, membranes removed easily, lots of lube, swearing, sweating and blood (took about 20-30mins) and it popped back! And my boss said it was a very large and tricky one from what he could tell and the cow kept trying to stand which didn't help. Now my legs and arms feel like I've been through an army workout and I've twisted my knee trying to position the cow but it feels good to have my first successful solo one Now to batten down the hatches, watch the flood waters gradually rise and crack open a bottle of vino!

Re: Uterine prolapse in a cow

mariette asselbergs — Wed, 21 Nov 2012 18:57:27 GMT

I did check for that (twisted uterus) but it wasn't the case. Although the farmer said the prolapse was very recent, I had my doubts because he had also not expected anythuing to happen since she had just weaned her calf. He was even initially not convinced that the cow had aborted, since he hadn't found a calf (in the field). The uterus did not look too bad, but there were already no membranes at all, just clean cotyledones. So I suspect it might have been a bit longer ago and maybe thats why the cervix was already so contracted. I assumed there would be a fifty fifty chance of surv ival with an amputation, but it would increase the bill quite a lot, and if it went wrong then there would no longer be an option for emergency slaughter as there was now, so we went for that.

Mariette

Re: Uterine prolapse in a cow

Michael Woodhouse — Wed, 21 Nov 2012 09:28:56 GMT

[quote user="mariette asselbergs"]

I considered amputation for a moment but did not try for fear of massive bleeding from the mesovaric arteries. Anybody experience with a similar case

[/quote]

Mariette,

There was a small case report in the Vet Record a few years ago about uterine amputation and IIRC 3/6 lived. It's one of those things filled in the back of my mind - I'd give it a go if the farmer wanted.

I mean this with all due respect - but you sure the uterus wasn't twisted externally? I have had similar once in position to replace - gave the impression of a closed cervix.

I once had a downer cow prolapse about a week after calving, that was hard to get back through the cervix.

Re: Uterine prolapse in a cow

Hannah Wynne Richards — Wed, 21 Nov 2012 09:24:02 GMT

The ones that go wrong are the downside of this job

Wynne

Re: Uterine prolapse in a cow

mariette asselbergs — Wed, 21 Nov 2012 07:32:43 GMT

Yesterday I had for the first time a cow sent to slaughter because I failed. She had aborted, then prolapsed and there was no trouble getting it back through the vulva, but the cervix had closed to 2 fingers width and it was impossible (for me?) to get the mass back through the cervix. It was a big disappointment, because she was very good and easy otherwise. I considered amputation for a moment but did not try for fear of massive bleeding from the mesovaric arteries. Anybody experience with a similar case?

Mariette

Re: Uterine prolapse in a cow

Mark Hedberg — Mon, 19 Nov 2012 10:46:30 GMT

Oh, I don't know, sometimes you just have a case where everything just goes perfect, and other times you just have cases that are an utter pig's ear. Certainly I couldn't reduce a bovine uterine prolapse in 10minutes, but that's mainly because i've never done any at all.

*shrug* neither here nor there, I know!

Re: Uterine prolapse in a cow

Hannah Wynne Richards — Mon, 19 Nov 2012 10:29:15 GMT

Micheal is either very good or very strong I'd say 20/30 mins average was more realistic

Wynne

Re: Uterine prolapse in a cow

Lucy K — Sun, 18 Nov 2012 16:32:44 GMT

[quote user="Michael Woodhouse"]

[quote user="Lucy K"]So, what is the average time that it takes to replace a uterus? [/quote]

10 minutes average, but that ranges from 1 minute to about 45!

That is actual pushing time not prep etc. It's a real trade off between pushing hard but remaining gentle.

Had a few in Limouisan heifers that just push back with the open palm of your hand.

[/quote]

Oh great! I always had images of uterine prolapses taking over 2 hours of blood, sweat and tears!

Re: Uterine prolapse in a cow

Michael Woodhouse — Sun, 18 Nov 2012 16:11:30 GMT

[quote user="Lucy K"]So, what is the average time that it takes to replace a uterus? [/quote]

10 minutes average, but that ranges from 1 minute to about 45!

That is actual pushing time not prep etc. It's a real trade off between pushing hard but remaining gentle.

Had a few in Limouisan heifers that just push back with the open palm of your hand.

Re: Uterine prolapse in a cow

Lucy K — Sun, 18 Nov 2012 14:05:19 GMT

So, what is the average time that it takes to replace a uterus?

Re: Uterine prolapse in a cow

Suzanne Kelly — Fri, 09 Nov 2012 00:01:18 GMT

After replacing uterus make sure you have them head facing downhill if on a slope. They're bloody hard work, I'm 5'2" and have never failed but I usually tell the farmer to make sure and offer some encouragement if I look like I might pass out and collapse in a heap on top of the uterus! It sound ludicrous but it actually does really help. I use a wine bottle too, but once I had a really huge holstein that sucked it into her uterus! I got the farmer to stick his hand in and he couldn't reach it either. I had to call back in the morning and retrieve it after letting the oxytocin do it's job. The shame.

The other thing is even if a uterus if really friable and you keep putting your hand through it and the stitches you put in to try and repair the damage keep cutting through, don't give up. I had one that was a total nightmare, every time I tried to stitch the stitches were ripping, but eventually got it back in. She's had at least 2 calves since. Cows are the most incredible animals

Re: Uterine prolapse in a cow

Michael Woodhouse — Thu, 08 Nov 2012 23:48:26 GMT

[quote user="Emily Rainbow"]

Naive student here who's not seen a prolapse in a cow yet...

Would bathing the prolapse in say hyperosmotic fluids help at all the reduce its size before putting it back? Or would the cost for such a large piece tissue make it unpractical? I've seen it done in dog vaginal prolapses with success, but obviously on a much smaller scale.

[/quote]

Emily, that is the theory of pouring on a bag of sugar. I have tried it and it may have reduced the size a bit bit it made an awful sticky mess that glued the bedding to the prolapse.The only advantage is the 5 minute break you get from pushing whilst the farmer goes and finds sugar (I have gone to the car to get xylazine for an epidural top-up as much for the break as any advantage it gave me).

There would be no point using sterile fluid on the uterus on the floor of a dirty barn. We get salt from Macro - think it's £1/kg. You could make a bucket of hypertonic saline for next to no money.

I think the sugar thing is in one of the James Herriot books.

Re: Uterine prolapse in a cow

Emily Rainbow — Thu, 08 Nov 2012 23:15:29 GMT

Naive student here who's not seen a prolapse in a cow yet...

Re: Uterine prolapse in a cow

Anthony Todd — Thu, 08 Nov 2012 22:05:18 GMT

[quote user="Michael Woodhouse"]I'd guess that maybe 5% mortality in good cases.[/quote]

[quote user="Michael Woodhouse"] I'm not as good as Anthony as I have had some die![/quote]

I just did the same as every other club vet. in NZ and certainly not as well as some, or my boss!!

Wasn't just me. We were 4 vets in Taranaki and 5 in Rotorua, but they were always less than 24hours but and perhaps sometimes we weren't informed of a subsequent death, so some might have died and we wouldn't have been told

My recollection was that death was not ever expected in a prolapse even, in a downer cow . The farmers used to get them to their feet with a hip clamp and a front-end loader which improved their attitude enormously. Getting them up = a survivor almost always.

And, of course, they got loads of parenteral Ca++ [be interesting to see if the prolapse was correlated with low [Ca++]???