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==Introduction==
==Introduction==
Prolapse of reproductive tract organs occurs in females '''during pregnancy or soon after parturition'''.
[[Image:Cervical Prolapse.jpg|thumb|right|200px|Prolapse,Copyright RVC 2008]]
[[Image:Prolapse.jpg|thumb|right|200px|Prolapse,Copyright RVC 2008]]
Prolapse of reproductive tract organs occurs in females '''during [[:Category:Pregnancy and Parturition|pregnancy]] or soon after [[parturition]]'''.
Cervical/vaginal prolapse is common in mature females in the '''last trimester''', when the cervix is unable to support the foetus.
Cervical/vaginal prolapse is common in mature females in the '''last trimester''', when the cervix is unable to support the foetus.
The vagina and/or cervix can also be expelled '''during delivery''' causing dystocia.
The vagina and/or cervix can also be expelled '''during delivery''' causing [[dystocia]].
Uterine prolapse occurs early in the postpartum period and can contain the urinary bladder.
Uterine prolapse occurs early in the [[Puerperium - Anatomy & Physiology|postpartum period]] and can contain the urinary bladder.
==Vaginal prolapse==
==Vaginal Prolapse==
Typically this is a disorder of '''ruminants occuring in late gestation'''. It occurs less frequently in pigs. In some bitches, hyperplasia of the vaginal mucosa occurs at oestrus, and sometimes protrudes through the vulva, but this is not comparable to the condition in the other species.
Typically this is a disorder of '''ruminants occuring in late gestation'''. It occurs less frequently in pigs. In some bitches, hyperplasia of the vaginal mucosa occurs at oestrus, and sometimes protrudes through the vulva, but this is not comparable to the condition in the other species.
The condition is a '''welfare concern''' and can have a considerable '''economic impact''' in flocks that experience a high incidence.
The condition is a '''welfare concern''' and can have a considerable '''economic impact''' in flocks that experience a high incidence.
===Predisposing factors===
===Predisposing Factors===
'''Hypocalcaemia, large foetal load, fat condition, inadequate exercise, short tail docking, excess dietary fibre, vaginal irritation, previous dystocia, inherited predisposition'''.
'''[[Hypocalcaemia]], large foetal load, fat condition, inadequate exercise, short tail docking, excess dietary fibre, vaginal irritation, previous dystocia, inherited predisposition'''.
===Clinical signs===
===Clinical Signs===
There is protrusion of varying parts of the vaginal wall and sometimes the cervix through the vulva so that the vaginal mucosa is exposed.
There is protrusion of varying parts of the vaginal wall and sometimes the cervix through the vulva so that the vaginal mucosa is exposed.
Animals might be '''clinically normal or show signs of exhaustion''', shock and anaerobic infections.
Animals might be '''clinically normal or show signs of exhaustion''', [[shock]] and anaerobic infections.
'''Abortion''' or premature delivery, often of a dead foetus, may occur.
'''Abortion''' or premature delivery, often of a dead foetus, may occur.
It is very important to replace the prolapse early to avoid any trauma and to ensure the animal maintains its pregnancy to term.
It is very important to replace the prolapse early to avoid any trauma and to ensure the animal maintains its pregnancy to term.
==Uterine prolapse==
==Uterine Prolapse==
This condition occurs '''after parturition''' and occurs sporadically in '''ewes, cattle, mares and sows'''.
This condition occurs '''after parturition''' and occurs sporadically in '''ewes, cattle, mares and sows'''.
The condition may be complicated by '''prolapse of the bladder, uterine rupture or intestinal herniation'''. One major concern is to prevent rupture of the '''large uterine vessels''' which will lead to rapid exsanguination.
Its occurrence is extremely rare in small animals.
The condition may be complicated by '''prolapse of the bladder, uterine rupture or [[Hernia|intestinal herniation]]'''. One major concern is to prevent rupture of the '''large uterine vessels''' which will lead to rapid exsanguination.
===Predisposing factors===
===Predisposing Factors===
'''Dystocia, forceful extraction of the foetus, retained placenta, vaginal lacerations and any condition causing straining after delivery'''.
'''Dystocia, forceful extraction of the foetus, retained placenta, vaginal lacerations and any condition causing straining after delivery'''.
===Clinical signs===
===Clinical Signs===
The uterus protrudes out through the cervix, vagina and the lips of the vulva. The visible surface is the inside of the uterus and it may appear swollen, reddened and dry. There might also be tearing and bleeding and the placenta may still be partly attached to the uterine lining.
The uterus protrudes out through the cervix, vagina and the lips of the vulva. The visible surface is the inside of the uterus and it may appear swollen, reddened and dry. There might also be tearing and bleeding and the placenta may still be partly attached to the uterine lining.
In small animals, one or both horns may be visible, and there may be tissue and oedema and trauma to the uterus.
===Treatment===
===Treatment===
'''Fluid therapy''' may be indicated if the animal is showing signs of shock and '''calcium''' might need to be administered.
<u>Large animals</u>
'''[[:Category:Fluid Therapy|Fluid therapy]]''' may be indicated if the animal is showing signs of shock and '''[[calcium]]''' might need to be administered.
'''Epidural anaesthesia''' can be used to reduce straining and aid replacement of the prolapse.
'''Epidural anaesthesia''' can be used to reduce straining and aid replacement of the prolapse.
Loose placenta can be removed but it should be left if it is firmly attached and if haemorrhage occurs.
Loose placenta can be removed but it should be left if it is firmly attached and if haemorrhage occurs.
To replace the prolapse, the animal should ideally be positioned with its '''hindquarters raised''', in a frog-legged position. Initially the vaginal prolapse is replaced, followed by the cervix and finally the uterus. Cupper hands and gentle pressure should be used so that trauma is not caused to the friable tissue.
To replace the prolapse, the animal should ideally be positioned with its '''hindquarters raised''', in a frog-legged position. Initially the vaginal prolapse is replaced, followed by the cervix and finally the uterus. Cupped hands and gentle pressure should be used so that trauma is not caused to the friable tissue.
Once the uterus is replaced, the '''tips of the horns''' should be examined to assess if they have everted, and using a bottle to lengthen the arm, or filling the uterus with water can help.
After reduction is complete, low doses of '''oxytocin''' can be administered to facilitate rapid uterine involution.
After reduction is complete, low doses of '''oxytocin''' can be administered to facilitate rapid uterine involution.
'''Systemic antibiotics''' are essential due to the risk of metritis and non-steroidal antiinflammatory drugs serve to counteract endotoxaemia.
'''Systemic antibiotics''' are essential due to the risk of metritis and [[NSAIDs|non-steroidal antiinflammatory drugs]] serve to counteract endotoxaemia.
The '''placenta may be retained''' following uterine prolapse, and this should be treated for subsequently.
The '''placenta may be retained''' following uterine prolapse, and this should be treated subsequently.
Post-replacement, uterine involution should be assessed per rectum and antibiotics should be continued until placental membranes have passed and the placenta is involuting satisfactorily.
Post-replacement, uterine involution should be assessed per rectum and antibiotics should be continued until placental membranes have passed and the uterus is involuting satisfactorily.
'''Death''' following prolapse is not uncommon, especially if haemorrhage occurs or help takes time to arrive.
'''Death''' following prolapse is not uncommon, especially if haemorrhage occurs or help takes time to arrive.
A simple prolapse with retained placenta has a '''good prognosis'''. '''Subsequent breeding is not contraindicated''' and a prolapse is no more likely to occur again. The condition is not a reason to discontinue breeding the animal unless the uterus was damaged.
A simple prolapse with retained placenta has a '''good prognosis'''. '''Subsequent breeding is not contraindicated''' and a prolapse is no more likely to occur again. The condition is not a reason to discontinue breeding the animal unless the uterus was damaged.
<u>Small Animals</u>
Immediate medical support should be put in place, with the provision of '''fluids and pain relief'''.
The animal should be anaesthetised and attempts should be made to '''replace the uterus''', using lubrication and great care.
If damage to the uterus is extensive, or the animal is not to be used for further breeding, '''ovariohysterectomy''' is the treatment of choice.
'''Broad spectrum antibiotic''' therapy should be instituted immediately.
Serious '''complications''' may occur such as rupture of the ovarian or uterine arteries leading to major bleeding and haemorrhagic shock.
{{Learning
|flashcards = [[Equine Reproduction and Stud Medicine Q&A 19]]
[[Cattle Medicine Q&A 03]]
[[Small Animal Emergency and Critical Care Medicine Q&A 11]]
}}
==References==
==References==
{{review}}
{{OpenPages}}
[[Category:Expert Review]]
[[Category:Reproductive Disorders]][[Category:Parturition]]
[[Category:Reproductive Disorders]][[Category:Parturition]]
[[Category:Reproductive Diseases - Dog]][[Category:To Do - Clinical]]
[[Category:Reproductive Diseases - Horse]][[Category:Reproductive Diseases - Dog]]
[[Category:Reproductive Diseases - Cattle]][[Category:Reproductive Diseases - Sheep]]