Prolapse of the uterus in the cow
Tim Potter BVetMed MRCVS
THE ROYAL VETERINARY COLLEGE, HAWKSHEAD LANE, NORTH MYMMS, HATFIELD,
HERTFORDSHIRE. AL9 7TA
Uterine prolapse is an uncommon complication of
parturition in the cow, but, when it does occur, rapid
and effective treatment is required to ensure the
survival, recovery and continued fertility of the
affected animal. Reported incidence varies from
0.002% (Roine & Saloniemi, 1978) to 0.6% (Correa
et al. 1992) of calvings. It usually occurs in the first
24 hours immediately post-partum, although there
are rare incidences of it occurring several days after
calving. Uterine prolapse occurs when the previously
gravid uterine horn becomes invaginated (folded in)
after calving and protrudes from the vulva.
PREDISPOSING FACTORS
Various predisposing factors have been suggested for
uterine prolapse in the cow:
1. hypocalcaemia
2. prolonged dystocia
3. fetal traction
4. fetal oversize
5. retained foetal membranes
6. chronic disease
7. paresis.
The condition is frequently associated with
hypocalcaemia, which results in lack of uterine tone
and delayed cervical involution. Risco et al. (1984)
collected blood samples from 53 cases of uterine
prolapse and 53 cows with normal parturition (no
prolapse) matched by dairy and management
programs. They found that multiparous cows with
uterine prolapse had significantly lower total serum
calcium content than the controls.
Fig. 1: Uterine prolapse in a recently calved cow.
UK Vet - Vol 13 No 1 January 2008
CLINICAL SIGNS
The clinical signs of uterine prolapse are dramatic
and obvious (Fig. 1). In the period immediately after
the prolapse occurs the tissues appear almost normal,
but within a few hours they become enlarged and
oedematous. Some animals will appear otherwise
healthy, although many animals will exhibit varying
degrees of hypocalcaemia:
• weakness
• depression
• subnormal temperature
• anxiety
• struggling
• prostration
• coma.
Some animals will develop hypovolaemic shock
secondary to internal blood loss (rupture of uterine
and/or ovarian blood vessels), laceration of the
prolapsed organ or incarceration of abdominal viscera.
Signs of shock, such as pale mucous membranes,
reduced capillary refill time and tachycardia are often
associated with a grave prognosis.
TREATMENT
Uterine prolapse remains one of large animal
practice’s true emergencies, with rapid intervention
improving prognosis. Owners should be instructed
to keep the animal quiet and the prolapse clean and
moist. If the animal is showing signs of severe
hypocalcaemia, calcium can be administered prior to
reduction.
It is possible to replace the prolapse in the standing
animal, although if difficulty is encountered the
animal should be cast using Reuff ’s method and
reduction should be undertaken as for a down cow.
The specific treatment of uterine prolapse is the
subject of much debate and there is considerable
individual variation as to when, or even if, certain
drugs should be given.
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CATTLE l CLINICAL 1
 Technique
Anaesthesia
A caudal epidural anaesthetic (see text box and Fig.
2) is administered to relieve tenesmus, allow easier
reduction of the prolapse and provide some pain
relief to the animal.
Caudal epidural
For a 600 kg bovine 5-10 ml of 2% procaine
solution will provide caudal anaesthesia without
causing hind limb ataxia or paralysis.
l The spinal cord in the cow ends in the region of
possible to replace the prolapse in the standing
animal.Animals that are recumbent should be placed
in sternal recumbency, with their hind legs pulled
behind them - the ‘frog-legged position’ (Fig. 3).
Pulling the hind legs caudally provides a mechanical
and gravitational advantage by tipping the pelvis
forward. If the animal is recumbent on uneven
ground it makes sense to utilise the natural
environment; positioning the animal so that she is
facing downhill can offer considerable mechanical
advantage.

the last lumbar vertebra, but the meningeal sac

extends on to the third/fourth sacral segments.
l Caudal epidural block is performed by insertion

of the needle between the first and second

coccygeal vertebrae - i.e. caudal to the
termination of the spinal cord and its meninges.
l The first intercoccygeal space can be located by

raising the tail in a ‘pump-handle’ fashion; the

first obvious articulation behind the sacrum is
C1/C2.
l Hair overlaying the space should be clipped, and
Fig. 3: ‘Frog-legged’ positioning, aids replacement by
the skin should be scrubbed and disinfected. tipping the pelvis forward.
l The skin can be desensitised with a small

amount of local anaesthetic; this helps minimise

movement when inserting the needle into the
epidural space.
l The point of the needle is placed in the centre of
the depression and advanced cranially and
ventrally at angle of 15° to the vertical (Fig. 2).
l The needle is advanced until it contacts the
The placenta should be removed gently (Fig. 4).
Usually the oedematous placentomes allow easy
separation of cotyledons from caruncles. Following
removal of the placenta the uterine surface should be
cleansed with dilute antiseptic solution.

ventral floor of the vertebral canal and is then

withdrawn approximately 0.5 cm into the
epidural space.
l Correct placement can be confirmed by placing

a couple of drops of anaesthetic in the hub of

the needle. Sub-atmospheric pressure in the
epidural space should lead to the drops being
aspirated (‘hanging drop technique’).
l Local anaesthetic can then be administered. No

resistance should be encountered to the

injection.
l Onset of paralysis of the tail should occur in 1-2

minutes.

Needle placement
Fig. 4: Gentle removal of the placenta prior to replacement of the prolapse.

The prolapsed organ should be elevated to the level

Cranial Caudal
Fig. 2: Placement of needle for caudal epidural in a cow.
Positioning
The cow is then positioned in a manner to facilitate
replacement of the prolapse. As stated earlier, it is
of the ischium; this enables easier reduction and
helps relieve vascular compromise. Elevation can be
achieved by having one or two assistants suspend the
organ in a sheet or towel, or by having an assistant
sitting on the cow’s sacral region, facing backwards
holding the organ upwards (Fig. 5).
Andrew White (2007) describes an alternative
method for prolapse reduction, involving raising the
rear end of the cow using a fore-end loading tractor.
The author has no experience of this technique, but

2 CATTLE l CLINICAL UK Vet - Vol 13 No 1 January 2008

if done correctly it appears to offer a useful
alternative in situations where there is an absence of
farm staff to help with uterine replacement.
Fig. 5: An assistant sitting on the cow’s sacral region
can aid replacement by lifting the prolapsed organ.
Oxytocin
Administration of oxytocin prior to replacement is a
matter of some debate. Some operators do, the
argument being that it reduces the size of the organ
to be replaced. Others prefer to administer oxytocin
after the prolapse has been reduced because of the
view that the contracted organ is harder to
manipulate. Route of oxytocin administration
appears unimportant, with intravenous or
intramuscular routes being advocated by most. Intra-
uterine oxytocin has been suggested by some;
although the author can find no evidence that this is
more efficacious.
Reduction
Replacement begins at the cervical pole of the organ
(closest to the vulva). The organ is gently pushed
back into position, taking care not to traumatise the
friable endometrium or uterine wall. Once replaced
it is important to ensure complete eversion of the horns.
Some practitioners will use a bottle as an ‘arm extension’
to help ensure complete eversion of the horns.
UK Vet - Vol 13 No 1 January 2008
Following replacement, temporary closure of the
vulva with a Buhner’s stitch (Fig. 6) can be
performed, but is deemed unnecessary by many. In
the author’s experience, as long as eversion of the
uterine horns is complete it is unnecessary to suture
the vulva.
Fig. 6: Placement of a Buhner’s suture - the closure of
the vulva following the replacement of a uterine
prolapse remains a matter for debate.
PROGNOSIS
Prognosis is generally favourable for uncomplicated
cases where there has been no serious damage to the
uterus. In one study, a two-week survival rate of
72.4% (Gardner et al. 1990) was found, with other
studies finding survival rates of 73.5% (Jubb et al.
1990) and 80% (Murphy & Dobson, 2002).
Primiparous animals were found to have a better
survival rate, as were animals who had delivered a
live calf. The absence of severe hypocalcaemia has
also been shown to be a favourable prognostic
indicator.
Despite the favourable prognosis it is also important
to consider the long-term effects on fertility. Work
has shown a negative impact of uterine prolapse on
subsequent fertility, with an increased culling rate for
infertility in cases of uterine prolapse when
CATTLE l CLINICAL 3
 compared to case controls. Murphy and Dobson
(2002) found the calving-to-conception interval was
50 days longer for re-bred prolapse cases compared
with matched controls.

REFERENCES
CORREA, M. T., ERB, H. N. and SCARLETT, J. M. (1992) A nested case-
control study of uterine prolapse. Theriogenology 37:939-45.
GARDNER, I. A., REYNOLDS, J. P., RISCO, C. A. and HIRD, D. W.
(1990) Patterns of uterine prolapse in dairy cows and prognosis after
treatment. Journal of the American Veterinary Medical Association
197:1021-4.
JUBB, T. F., MALMO, J., BRIGHTLING, P. and DAVIS, G. M. (1990)
Survival and fertility after uterine prolapse in dairy cows. Australian
Veterinary Journal 67:22-4.
MURPHY, A. M. and DOBSON, H. (2002) Predisposition, subsequent
fertility, and mortality of cows with uterine prolapse. Veterinary Record
151:733-5.
RISCO, C. A., REYNOLDS, J. P. and HIRD, D. (1984) Uterine prolapse
and hypocalcaemia in dairy cows. Journal of the American Veterinary
Medical Association 185:1517-19.
ROINE, K. and SALONIEMI, H. (1978) Incidence of some disease in
connection with parturition in dairy cows. Acta Veterinaria Scandinavica
19:341-53.
WHITE, A. (2007) Uterine prolapse in the cow. UKVet 12:1-3.

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These multiple choice questions are based on the above
text. Answers appear on page 99.
1. What is the reported incidence of uterine prolapse
in the cow:
a. 0.002-0.6% of calvings
b. 1-2% of calvings
c. 4-5% of calvings
d. 5-10% of calvings

2. What is the reported survival rate following

uncomplicated cases of uterine prolapse:
a. 50.5-60 %
b. 61.5-70 %
c. 72.4-80%
d. 80.4-80%

3. By how long is the average calving to conception

interval increased following a case of uterine
prolapse:
a. 20 days
b. 35 days
c. 45 days
d. 50 days

4 CATTLE l CLINICAL UK Vet - Vol 13 No 1 January 2008