by-DR RAJESH KUMAR SINGH, JAMSHEDPUR, JHARKHAND9431309542,rajeshsinghvet@gmail.comVaginal prolapse is a common obstetrical disorder for dairy cows throughout the country during 3rd trimester of gestation . Genital prolapses are mostly seen in ruminants specially cattle, buffalo, sheep, goat . It may be defined as coming out of one or more of the pelvic structures (bladder, uterus and vagina) from their normal anatomical position through the genital (vaginal) opening. Among all prolapse, uterine and vaginal prolapse are frequently observed in the reproductive tract of cow . Vaginal prolapse mostly happened in cross breed cattle before calving, usually in the last trimester of pregnancy . But there was also evidence of post oestral vaginal prolapse in a non-pregnant heifer . Severe straining at pre partum due to expulsion of fecal materials, increased intra-abdominal pressure at advanced pregnancy, enlarged rumen making the ligaments fragile around perineum , high level of blood estrogen , around parturition and deficiency of certain macro or micro minerals may act as potential key factors for vaginal prolapse. The successful surgical management of cervico-vaginal prolapse can be achieved by retention suture or Buhner’s suture technique. Vaginal prolapse is an emergency condition and it should be treated immediately before there may occur any trauma or laceration to prevent haemorrhage or bacterial infection. Sometimes the prolapse may cause infertility in subsequent pregnancy resulting impossible in retention to its normal position. The cure of vaginal prolapse depends on early diagnosis, immediate replacement of vagina and assurance of further recurrence . Various predisposing factors lead to uterine prolapse in the cow, i.e. hypocalcaemia, hypophosphatemia, hypomagnesemia, prolonged dystocia, fetal oversize, fetal traction, retained fetal membranes, chronic disease and paresisPre-partum recurrent prolapse of genital organs in cows are sporadically seen with Continuous or intermittent tenesmus, bulging mass of vagina and/or cervix through vaginal canal.Prolapse of vagina alone or concomitantly with cervix is less frequently occurring one of the gestational complications in dairy animals. The etiological factors may be attributed to the condition like higher estrogen secretion from placenta, heredity, mineral deficiency, increased intra-abdominal pressure, excessive relaxation, weakening and atony of the vaginal musculature, pelvic ligaments and, vulvar sphincter muscles, bacterial or fungal infections, and ingestion of phyto-estrogens, hormonal imbalance, etcIn managing cervico-vaginal prolapse various surgical or nonsurgical techniques and medicines are practiced with varying degrees of result. A successful management of recurrent prepartum vaginal prolapse in dairy cows/ buffalows are done using rope truss technique.The reproductive performance in buffalo is poor due to various diseases of the reproductive system, including genital prolapse . Prepartum vaginal prolapse is one of the major reproductive disorders in buffaloes. It mostly occurs in the seventh month of pregnancy or later immediately after parturition . Etiologic factors of prepartum vaginal prolapse in buffaloes may be attributed to nutritional imbalance , hormonal imbalance, seasonal-managemental factors and hereditary predisposition . The hormonal changes that occur during this last trimester of pregnancy, especially the increase of estrogen and the production of relaxin, cause a relaxation of the pelvic ligaments and surrounding soft tissue structures . Prepartum vaginal prolapse often terminate in uterine prolapse post-partum resulting from the infl uence of parturition. If infection is acquired, metritis or pyometra may result.
Treatment and Management Vaginal/Uterine prolapsed—The line of treatment of the vaginal /uterine prolapsed depend upon the condition and severity of the case. The condition may take place before parturition, it may take place post parturition with various degree so here are some general lines of treatment which are being practiced by field vets in India. The line of treatment may vary from vets to vets and case to case so it should not be taken as standard guideline for prolapsed treatment..TREATMENT AND HANDLING UTERINE PROLAPSE IN The CowUterine prolapse treatment given to the objectives is to get the good reposition and the absence of endometritis. Handling is the first clear the entire uterus with clean water containing low concentrations of disinfectants such as potassium permanganate one permil, revanol half permil, or can also lysol, carbolic acid with very low concentrations. While washing is also clear that linger well secundinae. Once the uterus is clean and the parent animal was given an epidural anasthesia, start repositioning held as follows:Lift the uterus is sticking out to the higher position of the female animals genitals. Put the uterus above the plank, or fabric shaped nets, to lift it more easily. Or if not, can be lifted by hand by two men. That all animals in a state where the parent stand. Enter the start of the uterus that is closer to the female animals genitals in a way little by little crammed. The parts that have been pushed further into the stomach cavity, finally by the weight of the uterus itself sliding into the abdominal cavity. This repositioning can be done with a cow standing up or lying down. But is easier if the cow stood still in a state. If during the process of repositioning the cow’s contraction, the need combined epidural anasthesia, due contraction to the presence of uterine re-enter to cavity stomach, the job will be in vain.If the uterus has returned entirely cavity stomach it must be held to prevent the uterus does not spit, the way is by sewing stitches called the female animals genitals with sutures used flessa or apron. Seam is opened so as not to cause damming and inflammation, after three days or we see is not there contraction. The uterus can be given 5-7 grams of streptomycin dissolved in 200-400 cc of distilled water. If the treatment is done neatly, thoroughly and clean without any contamination with foreign objects such as grass, hay, grain, or even worse faeces into the uterus, then the healing process can be quickly reached and 2-3 months later the cow was able to lust, and can married and pregnant.The Factors can help the process of handling:1. Prolapse treatment will be facilitated if the farmer was asked to wrap the prolapse uterus with a wet towel or cloth, or place them in plastic bags to keep the uterus remains moist and clean to be repositioned.2. Try standing on a cow uterus removed and maintained parallel to the female animals genitals until help arrived.3. Always try to cage floor clean and dry.4. Keep cows standing in the back of higher body.PRE PARTUM VAGINAL/UTERINE PROLAPSE TREATMENT IN COWS/BUFFALOWS—–During the first indication of low grade vaginal prolapsed, the cows & buffalos are treated with sodium salt of 4-dimethylamino-2 methylphenylphosphinic acid 0.2 gm (Tonophosphan® Vet Intervet®) injection 15 ml IM for 3 days and hydroxyprogesterone (Duraprogen® Vetcare®) Injection 2 ml (0.50 gm) by IM route for 3 days.The buffalo is also provided with rear elevation support using straw bags. The animal shows signs of improvement but vulvar lip closure is complete. A decrease in progesterone concentrations is reported in cows/buffaloes suffering with vaginal prolapse. Successful progesterone therapy in pre-partum vaginal prolapse in buffaloes and cattle has been reported indicative of the role of low serum progesterone concentrations in causing pre-partum vaginal prolapse. If After 20 days of treatment, prolapse may occur with higher grade, showing prolapse of the vagina even when animal is in standing position and straining is moderate. so a rope truss is applied for physical immobilization around the vulva. After successful delivery of calf, Follow up treatment is provided using Chromostat® (Adrenochrome Monosemicarbazone, Life Pharamceuticals) 25 ml IM as haemostatic once, Lixen IU (Cephalexine) 60 ml intrauterine for 3 days, Replanta® powder (Indian Herbs®) 50gm as commercial indigenous preparation for uterine cleansing twice daily for 3 days, Melonex plus® (meloxicam 5 mg and paracetamol 150 mg per ml, Intas Pharmaceuticals®) as anti-pyretic and analgesic 25 ml daily in two divided doses for 3 days, strepto-penicllin Dicrysticin® 2.5 gm (Sharabhia Zydus) is given as systemic antibiotic once daily by IM route for 5 days. We can also use strepto-penicllin, meloxicam and calcium borogluconate for managing pre/postpartum complications in cow/ buffalo.POST PARTUM VAGINAL/UTERINE PROLAPSE TREATMENT IN COWS/BUFFALOWS—–At first the perineal region of cow is washed with clean water. Then low epidural anesthesia is done at 1st intercoccygeal space using local anesthetic, 2% lignocaine hydrochloride (5ml) to prevent straining, easy control of tail and desensitization of pelvic region which facilitate easy manipulation of vagina into its original position. Then prolapsed mass is cleaned with normal saline and mild potassium permanganate solution to remove dirt. The prolapsed mass is lifted with both hands and replaced to vagina by using thumb fist. Then 2% lidocaine hydrochloride is administered subcutaneously into the lips of vagina where the gerlach needle is punctured . Buhner’s suture is applied with rope parallel to the vulva apart from vagina keeping one hand space for easy urination.It is suggested to keep the suture for 1 month and then removed it. The owner is told to take proper post-operative care for preventing recurrence. The cow is followed for next 2 months. As post-operative care vet administer DNS 5% (1 litre/ i/v/ day) for 5 days, calcium borogluconate ,500ml/day/i/v] for 5 days, Drotaverine hydrochloride , for 5 days. For topical application at vulvar lips 5% Povidin iodine is recommendedIn case, After few days of parturition, the cows/ buffalos start showing severe straining and this resulted in uterine proplase. Then in this case ,The prolapsed mass is first washed with potassium permanganate (1:1000) solution and urine is discharged using sterile stainless steel catheter and later the mass is manually repositioned and a jute rope truss is applied around the vaginal lip. Considering the possibility of contamination, the buffalo is treated with a broad spectrum antibiotic by the systemic route IM using Enrofloxacin 10% for 3 days and provided with an indigenous preparation of Prolapse-In (Cattle Remedies®) bolus 5 bolus twice daily for 3 days orally. Calcium and phosphorus is supplemented using intravenous slow infusion of 450 ml Mifex (Novartis®) once on the assumption that hypocalcium may be one the factor for the prolapse. Hypocalcaemia results in myometrial fatigue and delays cervical involution . There is appreciable improvement initially with decrease in straining and discharge of the placenta. However, again straining may be observed while urinating, urine is disrupted and the animal tends to remain in urinating posture for some time after urination . Straining is suspected to result from infection of the uterus resulting from contamination of the prolapsed mass at the time of uterine prolapse and the systemic antibiotic provided was not able to suppress the infection. Discharge of pus on rectal examination indicats development of clinical endometritisPuerperal metritis treatment may be attempted by intra-uterine douching with 60 ml of 5% Lugol’s iodine on alternate days for 3 days along with anti-allergic pheniramine maleate (Avilin®, Intervet India) 10 ml by IM route for 5 days and anti-infl ammatory Melonex plus® (Meloxicam 5mg and Paracetamol 150 mg per ml, Intas Pharmaceuticals®) 25 ml daily in two divided doses for 3 days. Lugol’s iodine is most commonly used under field condition to treat endometritis. Besides the antiseptic activity, Lugol’s iodine causes local irritation of endometrium, releases prostaglandin and regresses ovarian corpus luteum. Postpartum metritis is one of the most important disorders in buffaloes /cows , causing high economic losses due to prolonged intercalving intervals and cost of treatment . The severity of condition is decreased with thicker consistency and lesser pus discharge of rectal examination. The rope truss is also removed.Suspecting the possibility of urinary tract infection based on results of urine examination and clinical symptoms, the buffalo is treated with intra-urinary infusion of oxytetracycline hydrochloride (500 mg tablet Pfi zer® dissolved in 60 ml pyrogen free water) into the urinary bladder using sterile A.I. plastic sheet for 3 days and systemic intravenous administration of broad spectrum antibiotic combination of ceftriazone 3,000 mg and tazobactam 375 mg (Vetazo® Zydus Animal Health Limited) for 3 days. Melonex plus® (meloxicam 5 mg and paracetamol 150 mg per ml, Intas Pharmaceuticals®) 25 ml is also administered by IM route daily in two divided doses as supportive anti-infl ammatory therapy for 3 days. The buffalo/cow respond well to this treatment and straining decreases after 2 days of treatment with proper urine flow and no pus discharge with uterine tonicity is observed on rectal examination. There is also improvement in the feed intake of the animal and milk production
