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Cervico Vaginal Prolapse

Eversion or prolapsed of the vagina usually involves a prolapse of the floor, the lateral walls and a portion of the roof of the vagina through the vulva with the cervix and uterus moving caudal.

Cervico vaginal prolapse is seen in all species of domestic animals but most commonly in the cow and ewe.

*Cervico Vaginal Prolapse in Animals (Casting of the Wethers)*

Incidence

Seen commonly in all species of domestic animals but most commonly in the cow and ewe.
In late pregnancies- less than 1% of all obstetrical cases.
Prolapse of the vagina and cervix will invariably recur and become more severe during subsequent pregnancies.
Incidence of ovine vagino-cervical prolapse- 0.5%, it may reach 20%.
Commonly seen in young brachycephalic dogs during estrum
In cats- practically unknown

Etiology

Most commonly seen during the last 2 to 3 months of gestation when a large amount of estrogen is being secreted by the placenta. This causes a relaxation of the pelvic ligaments and adjacent structures, vulva and vulvar sphincter muscles.
When the cow lies down the intra abdominal pressure is transmitted to the flaccid structures tending to force the related and loosely attached vaginal floor and walls through the vulva.
Atony of the reproductive tract and general weakness of the patient.
Hereditary or genetic factors.
More common in pleuripara than primiparous cows.
Injuries or stretching of the birth passage of the first or subsequent parturition may predispose in the following gestation.
Close confinement for long periods especially in stanchion in which the cows rear parts projected over the gutter.
Over distension of abdomen or excessive pelvic fat favour the condition by increasing the intrapelvic pressure.
Feeding of mouldy com or barley cause edema of the vulva, relaxation of pelvic ligaments, tenesmus and prolapse of the vagina and even rectum.
In dogs, it occurs during proestrus and estrus and regress during metestrus.

Pathogenesis

When an animal becomes recumbent on an inclined plane with its hind quarters positioned downward due to a combination of some factors, will lead to prolapse.
In initial cases, spontaneous reduction occurs when the cow rises.
Recurrent prolapse often causes bruising, soiling and infection, and in turn leads to the development of inflammatory swelling of the mucosa.
An increase in swelling of the mass occurs due to inhibited venous blood return.
Progressive circulatory embarrassment results in thrombosis and finally leading to necrosis.
Mass reaches a size which prevents spontaneous reduction resulting in permanent condition.

Classification

First degree Prolapse

The floor of the vagina protrudes intermittently through the vulva, usually only when the cow is lying down and disappears when she stands up.

Second degree Prolapse

The prolapse in which the floor of vagina is in continuous even when the cow stands up.

Third degree Prolapse

The prolapse in which both the cervix and almost the entire vagina remain protrude.

Fourth degree Prolapse

Second or third degree prolapse that has been exposed for long period and leads to necrosis and fibrosis.

Symptoms

Symptoms of vagino-cervical prolapse are obvious and the condition is often spoken of by the farmer as “Casting of the wethers “.

Symtoms are obvious.
Straining or tenesmus may be absent, intermittent, mild or severe and nearly constant depending upon the degree of the prolapse, the degree of inflammation, edema and irritation in the genital tract and the degree of distention of the bladder.
Edema of the prolapsed vagina and cervix occurs because of the irritation and trauma to the exposed mucous membrane and because this portion drops over the ischial arch thereby causing a passive venous congetion. The edema accumulates in the sub-mucosa and cause a separation of the mucosa from the underlying thin muscular vaginal wall.
The cervical seal usually remains intact, although if the cervix is prolapsed and inflamed, the external portion of the seal may be absent and causes abortion or premature birth occurs within 24-72 hrs.
Usually, prolapsed vagino-cervical mass size varies from ~10 cm to over 30 cm in diameter.
Neglected cases may lead to uterine infection and death due to necrosis and gangrene.
Prolapsed with urinary bladder is an emergency condition. It may lead to accumulation of urine progressive uremia or rupture of bladder.

Prognosis

Depends upon the severity of the condition and the length of time it has existed.
Except in extreme or severe cases, the prognosis is generally fair to good for the life of the animal and the fetus if treatment is prompt and after care is good.
Cows usually calve without any assistance in nearly all uncomplicated cases.
After parturition the prolapse is usually immediately relieved.

Management and Treatment

The management and treatment of vaginal prolapse include vulval tape retention suture, Bühner’s method, Caslick’s operation (vulvoplasty), Minchev’s technique, Winkler’s method, Farquharson’s method, and the Guard and Frank technique.