ISSN 2398-2993      

Cervical/vaginal prolapse

obovis
Contributor(s):

Ash Phipps

Neil Paton

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Synonym(s): vaginal eversion


Introduction

  • Vaginal prolapse occurs when varying degrees of vaginal tissue protrude outside of the vulval lips. This tissue is vulnerable to trauma and desiccation.
  • The condition is common in pregnant cows (usually occurring after the 5th month of gestation).
  • Predisposing risk factors for vaginal prolapse include:
    • Mature females in their third trimester of pregnancy due to increased intra-abdominal pressure with increased size of uterus and intra-abdominal fat. In combination with increase on concentration of oestrogens and relaxin which results in softening of the pelvic girdle and associated soft tissues.
    • Distension of the rumen and prolonged recumbency (these both result in an increase in intra-abdominal pressure.
    • Exogenous estrogenic compound supplementation.
    • Repeated superovulation treatment for embryo retrieval.
    • Note: breed predisposition – Hereford Hereford and Brahman Brahman cattle.
  • Vaginal eversion is classified into 4 grades, depending on the severity of the eversion and the degree of tissue damage.
    • Grade 1: A small area of the vaginal tissue is everted through the vulval lips intermittently. Minimal trauma and desiccation occurs to the exposed tissues.
    • Grade 2: Vaginal tissues are everted through the vulval lips continuously.
    • Grade 3: The entire vaginal tissue and the cervix protrude through the vuval lips continuously. The urinary bladder often becomes entrapped in the prolapsed tissues. With Grade 3 vaginal eversion, the tissues become traumatized and desiccated, and the cervical plug is lost in therefore increasing the risk of uterine infections +/- placentitis/fetal death.
    • Grade 4: This grade is divided into two grades, 4a and 4b. Grade 4a eversion is often referred to as cervical eversion as only the cervix everts through the vulval lips as a pedunculated mass through the vulva. Whereas, Grade 4b eversion is where both the cervical and vaginal tissues are protruding through the vulval lips and the tissues have become necrotic and fibrotic (chronic condition). The affected animal will be predisposed to infection, bladder entrapment and compromise and possible peritonitis.
  • Regardless of the grade of vaginal eversion, the end goal is to replace the everted tissues, in a timely manner, and prevent the tissues from re-everting. For pregnant animals, a secondary objective is to allow the cow to give birth and rear a calf to weaning age.
  • This article describes the technique to replace bovine cervical/vaginal prolapses.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • This will be dependent on the grade of the prolapse and the degree of tissue that is compromized.

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Bhattacharyya H K, Fazili M R, Buchoo B A & Akand A H (2012) Genital prolapse in crossbred cows: prevalence, clinical picture and management by a modified Bühner’s technique using infusion (drip) set tubing as suture material. Veterinarski arhiv 82 (1), 11-24.
  • Miesner M D & Anderson E (2008) Management of Uterine and Vaginal Prolapse in the Bovine. Vet Clin Food Anim Pract 24, 409-419 VetMedResource.

Other sources of information

  • Hopper R M (ed) (2014) Bovine Reproduction. John Wiley & Sons. pp 383-395.
  • Fubini S L & Ducharme N (2004) Farm Animal Surgery. Elsevier Health Sciences, USA. pp 396-397.

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