13. Disorders of the puerperium (uterine prolapse, retention of placenta)

What is uterine prolapse?

Protrusion of part or all of the uterine horns and body through the vulvar lips

Is uterine prolapse common or rare?

Rare

What are the two types of uterine prolapse?

Incomplete (cylindrical) and complete (Y-shape)

When can uterine prolapse occur?

Prior, during, or after parturition

What are the causes of uterine prolapse?

1. Severe straining or manual pulling during delivery

2. Excessive bleeding or hypocalcaemia

3. Prolonged labour

What are the clinical signs of uterine prolapse?

Abdominal pain, straining, bleeding, presence of uterus in vulva, haemorrhage (uterine artery) leading to hypovolemic shock

How is uterine prolapse diagnosed?

Palpation of a firm tubular mass protruding from vulva, absence of uterus on USG

What is the treatment for uterine prolapse?

Reposition with speculum + warm saline/hypotonic dextrose if fresh, or OHE, or amputation of prolapse, give oxytocin and antibiotics post-op

What is retention of placenta?

Failure to expel the placenta after parturition

Is retention of placenta common or rare?

Rare

When should the placenta typically be expelled after parturition?

A couple of days after parturition

What are the causes of retention of placenta?

Large litter, more common in toy breeds

What are the clinical signs of retention of placenta?

Green discharge, restlessness, depression, fever, refusal to allow puppies/kittens to suckle, septicaemia, toxaemia

What are the consequences of retained placenta?

Atony of uterus, placentitis, placental necrosis, toxaemia, toxic milk syndrome in puppies (crying, dehydration, death of puppies)

How is retention of placenta diagnosed?

USG, vaginal exam, abdominal palpation, endoscopy, presence of dark green membranes/discharge

What is the initial treatment for retention of placenta?

Oxytocin

What is the secondary treatment for retention of placenta if oxytocin is ineffective?

Removal of placentas (forceps + speculum), antibiotics (amoxicillin), repeated low-dose prostaglandins, possibly OHE

Why is rapid control of haemorrhage in uterine prolapse important?

To prevent hypovolemic shock.

Which breeds are more predisposed to dystocia?

Brachycephalic breeds

What is the treatment of uterine prolapse if it occurs just before or during prolapse?

C-section