CLINICAL APPROACH FOR MANAGEMENT OF PROLAPSE
Dr.Deepak Kumar Chaurasia
Assistant Professor, Department of Veterinary Gynaecology and Obstetrics, IVSAH, SOA-DU, Bhubaneswar, Odisha – 751030, India
INTRODUCTION
Prolapse is commonly occurring post-partum complication in farm animals including buffaloes, cow, ewes and does. Causes of prolapsed are multiple including twin pregnancy,dystocia,higher oestrogenic content in blood,mineral imbalance,increased intra abdominal pressure,loosening of vaginal musculature,urinary infection etc. Hypocalcaemia leads to atony of genitalia and cause prolapse. Prolapse of uterus is regarded as one of the major reproductive disorders in buffaloes and cause great economic loss to farmers.However, exact etiology and epidemiology of this condition remains unclear. Hypocalcaemia results in atony of uterus and delay cervical involution, both of which could predispose to uterine prolapse in buffaloes.
Cow that are limited to grazing clover pastures could be at a higer risk of vaginal prolapse due to a toxic agent that can be produce by the forage.To help prevent vaginal prolapses, it is important to restrict cow from becoming overly fat durig the last trimester of pregnancy by providing a ration to keep herd with a good body condition score but not overly conditioned.
TYPES OF PROLAPSE
Vagino-cervical prolapse
This condition is featured by prolapse of vagina which usually involves vaginal floor, lateral wall of vagina and some position of vaginal root through valva with cervix and uterus moving caudally.
It is seen in all spp. of domestic animal but most common in cow, especially in Hereford, Brownswiss and Holstein. (In Indian breed RedSindhi and its crosses.) Other spp. like Ewe and brachycephalic breed of dog are affected.
It is observed in the cow most commonly the last 2 to 3 month of gestation when a large amount of estrogenic hormone is being secreted by the placenta.
Uterine prolapse
It is called as casting of wethers or casting of calf bed. It follows a forcefull extrction of foetus in condition like oversize foetus, uterine inertia and in retention of placenta. Once uterine prolapse occurs animal is supposed to undergo uterine prolapsed every year.
Uterine prolapse always occur after parturition and prognosis is always guarded. In neglected case there is gangrene in uterus, may be associated with anemia, sever hemorrhage due to loss of caruncle. There is complete sloughing of uterus in neglected case.
When there is loss of more than 10% maternal caruncle, the future reproductive performance is reduced.Animal finally becomes sterile.
ETIOLOGY OF PROLAPSE
- Hormonal Factor:-
In cow in last 2-3 month of gestation due to secretion of large amount of estrogen from placenta there is relaxation of pelvic ligament, vulva and vulvar sphincter muscle which are oedematous in nature.When cow lies down intraabdominal pressure aggravate the condition causing prolapse.
- Nutritional Factor:-
Feeding of estrogenic fodder like berseem etc.or use of estrogen hormone that may be one of the predisposing factor for genital prolapse.Lack of vitamins and minerals especially Ca, because Ca is helpful for tonicity of uterus.
- Cowshed:-
The cow which is maintained in the shed is generally confined. Reared part is placed in slanting position projected towards gutter.
- Intra-vaginal irritant such as higher concentration of Lugols iodine may be one of the predisposing factors for genital prolapse.
- Straining or increased intra abdominal pressure due to constipation, bloat/tympany.
- Hereditory or genetic predisposition.
MANAGEMENT&TREATMENT
- Mild cases:-
- In slight prolapse cases, the animal should removed from the stanchion and allow for exercise.
- Elevate the rear part of cow by raising 2 to 6 inches higher than the front quarter.It may be done by building up the bedding by wheat/paddy straw or sand bag under rear quarter or digging out the soil under the front quarter.
- Ca therapy is one of the most successful protocols for handling cervico-vaginal prolapse. Reduce the quantity of green and estrogenic fodder.
- Application of vulvar truss:-These tusses may be made of rope, leather or metal. Trusses are held in place by ropes or leather straps securely fastened around the cow of chest and neck. The truss fits over the vulva, may be padded with towelling to prevent abrasions or necrosis where it lies against the ischial arch
- Moderate cases:-
- Cleaning and washing of prolapsed mass with cold water and antiseptic solution (potassium permagnet dissolved in water 1:10000 concentration.)
- If mass is not injured or lacerated, straining may be controlled by caudal epidural anaesthesia the prolapsed mass is replaced back after applying non irritant antiseptic lotion and follow all the aspects described in mild cases.
- Severe cases (chronic recurrent cases)
- Vulvar sutures:
This method is used for treating vaginal prolapsed especially the last 2 to 3 week of gestation.The sutures should be located at least 2 to 3 inches lateral to the vulvar lips in the hair line that do not pass through the vulvar lips.In this method horizontal mattress suture are used.
- Reefing operation/submucous resection:-
This operation is performed for correction of chronic vagino-cervical prolapsed in which dead necrosed part of prolapsed mass is incised and removed in order to reduce the size and after that prolapsed mass placed in original position.
This operation is performed under epidural anaesthesia. Adrenaline injected or locally applied to reduce hemorrhage during the peeling off of the necrotic, edematous mucous membrane.
- Buhner’s method:-
Through large needle two stab incisions are made in the midline under epidural anaesthesia. The upper one is midway between the dorsol commisure of the vulva and anus, while the lower one is immediately beneath the ventral vulval commisure.
The Buhner’s needle is inserted into the lower incision and gradually passed subcutaneously up in the right side of vulva until its point emerges through the upper incision,then place the ribbon/tape in the eye of neddle and withdrawl the needle back so the ribbon cover the whole length.
Do same at other site and after that tie the simple slippery knot in the end at bottom of vulva. The suture can remain in place for weeks or months for preventing the prolapsed .While approaching parturition the relese of the knot allows the vulva to dilate for the birth of the calf.
- Caslicks operation:-
This operation generally employed for mare by vulva closing technique in controlling tenesmus associated with windsucking and a highly inflamed vaginal and vulvar mucous membrane.
CONCLUSION
The proper maintenance of dairy animals in terms of hygiene of previous calving, provision of balanced ration, maintenance of good body score condition should be to avoid pre-partum cervicovaginal prolapsed in dairy animals.
