Yordan Yordanov, DVM
Bomed Veterinary Clinic – Sofia
Uterine prolapse is a relatively uncommon complication of parturition, occurring infrequently in cats. Ekstrand and Linde-Forsberg reported it as accounting for 0.6% of the maternal causes of dystocia. The etiology of uterine prolapse is unknown in queens. The prolapse can be complete, with both horns protruding from the vulva, or limited to the uterine body and one horn. Uterine prolapse requires immediate attention. It is an obstetric emergency.
A 1-year-old female European Shorthair outdoor cat weighing 2.5 kg was presented to our clinic with 96h after parturition. Two days before presentation his caretaker saw “something like placenta to hanging behind the cat”.
On physical examination, the animal was alert, 38.3 °C and slightly dehydrated. The pulse and respiratory rate were both within normal ranges. The prolapse of the uterus was complete, with both horns protruding from the vulva. The exposed tissue was congested and slightly edematous with a few small areas of necrosis, and was covered with debris.
The exposed uterus was palpated to rule out the possible presence within it of any abdominal organs such as the urinary bladder.
Tips & Tricks. Ultrasound examination of the abdomen and the uterine prolapse can be performed to reveal the position of the urinary bladder and the intestine.
Tips & Tricks. Topical application of Manitol 10% can be performed to reduce the oedema in prolapsed tissue.
CBC and biochemical analysis were performed. CBC showed WBC 38.8 x109/l, HGB 89 g/l, HCT 0.265 l/l. Other parameters of the biochemical analysis and packed cell volume were all normal in range.
After premedication with domitor/buprenorphine/ketamine, anesthesia was induced with propofol after preoxygenation. An endotracheal tube was inserted and anesthesia was maintained with isoflurane. Preoperative antibiotics: Cefazoline i.v. and enrofloxacine s.c.
The surgery was performed in two steps: first the replacement of the prolapsed horns and uterus and then ovariohysterectomy.
Tips & Tricks. If the prolapsed organ is in very good condition and the cat is a valuable breeding animal you can try conservative treatment. Replacement, following by medical treatment Oxitocin (0.5-1.0 UI) and antibiotics. Complications may develop from minor laceration of the uterus to septicemia or uterine rupture.
Tips & Tricks. Do OHE! It is the safest option in this situation.
Tips & Tricks. OHE can be performed before reduction if the uterus is too contaminated or necrotic or ruptured.
In this reported case the uterus looked in good condition.
Gross debris was removed gently from the prolapsed organ by irrigation with hypertonic solution.
Then the uterus was reponeted carefully, starting from tip of the horns, one by one.
Tips & Tricks. Use some type of lubricant, like Vaseline.
Tips & Tricks. Oxytocin 0.5 IU can be administered directly in prolapsed tissue to facilitate uterine involution prior to replacement. Attention! Oxitocin make uterine tissue fragile.
Tips & Tricks. An episiotomy may be performed to assist uterine replacement.
Tips & Tricks. Cystocentesis may be performed before attempting to reposition the uterus.
Tips & Tricks. Use monofilament suture material, like PDS 2-0 for cervix ligatures. Polyfilament suture can cut the weakened uterine tissues like saw.
Apposition of vulvar lips was performed with a horizontal mattress pattern without tightening to allow vulvar discharge and normal urination.
This suture was removed after 24 h.
The queen recovered well. Postoperative treatment included the use of an Elizabethan collar and intravenous fluid therapy.
The day after surgery, the cat was alert, urinated normally and there was mild discharge from the vulva.
Antibiotic treatment for 5d amoxicillin/clavulanic acid -Synulox and Enrofloxacin.
Tips & Tricks. Postoperatively, urination should be monitored as swelling and pain can lead to urethral obstruction.
Although rare, uterine prolapse should be managed as an emergency. The treatment for uterine prolapse depends upon the severity of damage to the uterus. The prognosis following treatment for a uterine prolapse is guarded to good, depending on the timing of veterinary intervention.