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Correction and management of uterine prolapse in a Holstein Friesian cow

Article · December 2017

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Asian Australas. J. Biosci. Biotechnol. 2017, 2 (3), 251-254

Asian-Australasian Journal of
Bioscience and Biotechnology
ISSN 2414-1283 (Print) 2414-6293 (Online)
www.ebupress.com/journal/aajbb

Short Communication
Correction and management of uterine prolapse in a Holstein Friesian cow
Pranab Paul1, Md. Monir Hossan2, Saroj Kumar Yadav1 and Tanjila Hasan1*
1
Department of Medicine and Surgery, Faculty of Veterinary Medicine, Chittagong Veterinary and Animal
Sciences University, Khulshi, Chittagong-4225, Bangladesh
2
Veterinary surgeon, Manikganj Sadar, Manikganj, Bangladesh

*Corresponding author: Tanjila Hasan, Department of Medicine and Surgery, Faculty of Veterinary Medicine,
Chittagong Veterinary & Animal Sciences University, Khulshi, Chittagong-4225, Bangladesh. Phone:
+8801735509192; Fax: +880-031-659620; E-mail: tanjila.cvasu@gmail.com

Received: 22 October 2017/Accepted: 03 December 2017/ Published: 31 December 2017

Abstract: A three years old Holstein Friesian (HF) cow with a history of premature calving was brought to the
clinics of Veterinary college and Research Institute, Nammakal. The cow showed protrusion of mass through
the vulva after its first calving. On clinical examination animal was apparently healthy and confirmed as uterine
prolapse. The Uterine prolapse was corrected manually following proper precautionary measures. To prevent
the recurrence, Buhner’s suture was applied. Animal had an uneventful recovery.

Keywords: Holstein Friesian cow; uterine prolapse; buhner’s suture

1. Introduction
Uterine prolapse is the protrusion of the uterus from the vulva with the mucosal surface exposed (Gustafsson et
al., 2004; Kornmatitsuk et al., 2004). Uterine prolapse occurs most often immediately after parturition and
occasionally up to several hours afterward. The presence of a part of the fetal membrane in the genital passage
induces strong tenesmus and prolapse. Various predisposing factors have been suggested for uterine prolapse
in the cow, e.g. hypocalcaemia, prolonged dystocia, fetal traction, fetal oversize, retained fetal membranes,
chronic disease and paresis (Risco et al., 1984; Reynolds et al., 1984; Ishii et al., 2010; Aoki et al., 2010).
Prolapse of the uterus at post parturient period through the genital passage and it’s expulsion outside the body is
a frequent sequel to protracted dystocia. Uterine prolapse has been recorded in all species of animal, although
most commonly seen in pluriparous dairy cows occurring immediately after parturition and occasionally after
several hours (Roberts, 1971; Simon et al., 2015). Incidence of post partum uterine prolapse varies from 6.6 %
to 12.9 % (Nanda and Sharma, 1982). In the period immediately after prolapse the tissues appear almost normal,
but within a few hours they become enlarged and edematous. Some animals will develop hypovolaemic shock,
secondary to internal blood loss, laceration of the prolapsed organ or incarceration of abdominal viscera
(Ramsingh et al., 2013; Mohan et al., 2013). It is regarded as a veterinary emergency because without treatment,
the cow is likely to die (Murphy and Dobson, 2002; Miesner and Anderson, 2008). The method of raising the
rear end of the cow using a tractor was reported as a quick, easy and essentially practical method of dealing with
a prolapsed uterus (Ishii et al., 2010; Aoki et al., 2010). This case report describes the successful correction of
uterine prolapse in a cow.

2. Case presentation & history

The three years old primiparous HF cow was presented with history of protrusion of mass through the vulva
since seven hours after parturition. She delivered a male calf. On gynaeco-clinical examination the cow was
apparently healthy with moderate tenesmus and the physiological parameters were within the normal range. The
prolapsed mass was larger, longer (hanging down to the hocks when standing) (Figure 1), more deep red in
Asian Australas. J. Biosci. Biotechnol. 2017, 2 (3) 252
colour and covered with foetal membranes. The prolapsed mass was also edematous, engorged and soiled with
faeces, straw, dirt and blood clots.

3. Surgical management
a. General approach
Before to the treatment physical examination was done and recorded the temperature, pulse rate, respiration rate,
body weight etc. Blood sample was collected for the estimation of hemoglobin, ESR, total count of RBC, total
count of WBC, PCV, lymphocyte, neutrophil, eosinophil, monocyte, basophil, serum calcium, serum
magnesium, serum phosphorus, S.GOT and S.GPT.

b. Correction of uterine prolapse

Caudal epidural anesthesia was done with 5ml 2% lignocaine HCl for prevention of straining. Then the partial
foetal membrane was carefully separated avoiding damage to maternal caruncles and bleeding. The tissue debris
was removed by washing and cleaning the prolapsed mass with water (Figure 2). The prolapsed mass was
thoroughly irrigated with 1:1000 potassium permanganate solutions (Figure 3). With gloved and lubricated
hand, the everted uterus was pushed through the vagina by manual pressure to regain its normal position (Figure
4 and Figure 5). To prevent further complications, intrauterine four Furea boli were kept in uterus. Re-occurance
of prolapse due to tenesmus was prevented by applying Buhner’s suture (Figure 6). The suture was removed
after 14 days. The cow recovered uneventfully without any complications (Figure 7).

c. Post operative care

Calcium borogluconate solution [45ml, intravenously], antibiotic [Streptopenicillin, 7.5ml, intramuscularly],
antihistaminic [20ml, intramuscularly] and dextrose saline [(20%) 2000ml, intravenously] were injected for 7
days.

3. Results and Discussion

The cow showed good recovery without recurrence and other complications. The suture was removed after two
weeks. The incidence of uterine prolapse registered frequently in cattle and sheep (Bhattacharyya et al., 2012;
Fazili et al., 2012). It is generally noticed during immediately post-partum especially after dystocia (Sah and
Nakao, 2003). But in the reported case, the prolapse was observed in HF cow after normal parturition of a male
calf. The objective in the treatment of uterine prolapse was replacement of the organ to its original position and
prevention of recurrence. The usual sequel of uterine prolapse is haemorrhage, shock, septic metritis, peritonitis,
infertility or death. Bhattacharya et al. (2012) reported 9.09% mortality rate and 18.18% cows developed
metritis. However, careful removal of dung and dirt materials using potassium permanganate solution prevented
the uterine infection in this case as noticed by Simon et al. (2015) and Gupta et al. (2015). Elevation of hind
quarters helps in repositioning of prolapsed uterus with good recovery rate (Ishii et al., 2010; Aoki et al., 2010).
It was observed that the hygienic handling, proper management and treatment should definitely prevent further
reproductive tract damage and aid in quick recovery.
In this case hematological parameter showed low serum calcium level (7.5 mg/dl) (Table 1) indicating
hypocalcaemia. Decreased level of calcium can lead to reduced vaginal and uterine muscle tone which
predisposes the animal to prolapse (Noakes et al., 2009). Based on the results of the present study, deficiency of
calcium (7.5 mg/dl), magnesium (1.6 mg/dl) and phosphorus (3.2mg/dl) might be the possible factor that leads
to prolapse of genital track in cow. Besides biochemical observation, the blood sample was also tested to detect
different blood parameters (Table 2). The result showed that there was increased level of ESR (12 mm in 1st
hour) and decreased PCV (22%). According to Jain (1986), ESR increases in inflammatory conditions and in
acute generalized infection. This result is in agreement with those of Kinney (1967), who stated that the
decrease in PCV in prolapsed animals might be due to possible release of antidiuretic hormone as a result of
stress.

Table 1. Biochemical blood analysis in cow suffering from uterine prolapse.

Name of the test Result Normal Range

Serum calcium 7.5 9.7-12.4 mg/dl
Serum magnesium 1.6 1.8-2.3 mg/ dl
Serum phosphorous 3.2 5.6-6.5 mg/dl
Asian Australas. J. Biosci. Biotechnol. 2017, 2 (3) 253
Table 2. Routine blood test in cow suffering from uterine prolapse.

Name of the test Result Normal Range

Hemoglobin 8 8-15 gm%
ESR (Wintrobe tube method) 12 6-10 (mm in 1st hour)
Total count of RBC 5 5-10 million/ cumm
Total count of WBC 6 4-12 thousand/ cumm
PCV 22 24-46%
Lymphocytes 72 45-75%
Neutrophils 25 15-45%
Eosinophils 6 0-20%
Monocytes 3 2-7%
Basophils 1 0-2%

Figure 1. Hanging prolapsed Figure 2. Cleaning the prolapsed mass

uterus. with water.

Figure 3. Application of potash Figure 4. Application of lubricant in

water in the uterine mass. the uterine mass.

Figure 5. Repositioning the Figure 6. Applying Buhner’s

prolapsed mass. suture.
Asian Australas. J. Biosci. Biotechnol. 2017, 2 (3) 254

Figure 7. Recovered cow.

4. Conclusions
Uterine prolapse may appear in peri-parturient period. Diagnosis and treatment of uterine prolapse is very much
important task. Delayed in correction may cause some critical condition such as edema, fibrosis, necrosis,
septicemia. So the farmers and veterinarians should be careful about early recovery of the condition which will
save the cow from life-threatening condition.

Acknowledgements
Authors are thankful to the Director of Teaching Veterinary Hospital, Chittagong Veterinary and Animal
Science University and All the members of Veterinary college and Research Institute, Nammakal for providing
necessary facilities to this case study.

Conflict of interest
None to declare.

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