Management of Antepartum Cervicovaginal Prolapse in Buffaloes

Management of Antepartum Cervicovaginal Prolapse in Buffaloes

Buffaloes comprises 21.23% of total livestock of the India with the total population of 108.7millions (19^th Livestock Census). The India is at first rank in the world comprising with more than half population of world buffaloes found here. Buffaloes are contributing more than half in the total milk production in the India and are thus forming major part in the Indian economy. Out of total buffalo population in the India, majority is been reared by small and marginal farmers and mainly stall-fed. Buffaloes differs in many significant ways from the cows and also the incidence of many diseases are more in buffaloes leading to their poor reproductive performance. The most devastating disease causing huge economic losses to the farmers is the antepartum prolapse of vagina and cervix. It is the protrusion of the vagina and cervix through the vulva in the advanced pregnant animals. The cervicovaginal prolapse has more incidences in buffaloes and is more related to pluriparous animals as compared to primiparous animals. This is associated with mainly last 2-3 months of pregnancy but cases are also reported in 5-6 months pregnant animals also. Antepartum prolapse is associated with many complications during the pregnancy as well at the time of parturition and after parturition in the form of puerperal metritis, retention of placenta, postpartum prolapse, decreased appetite and milk yield etc. Proper care and management of buffaloes with special attention to the nutrition can decrease the incidence of prolapse and also can also help in its management to prevent reoccurrence.

Causes of cervicovaginal prolapse

            The exact cause of cervicovaginal prolapse in buffaloes is not known but many factors are there which predisposes the animal and are associated with the incidence of antepartum cervicovaginal prolapse in buffaloes.

1. High level of Estrogen: There are more chances of occurrence of ante partum prolapse in buffaloes 6.5 months onwards of pregnancy. High level of estrogen is supposed to be one cause of prolapse in buffaloes in the late pregnancy. This increased level of estrogen is associated with the relaxation of the sacrosciatic ligaments and the pelvic structure loosening with vulvar edema and predisposes the animal for prolapse of reproductive organs. Some feeds like berseem, moldy barley and maize are also high in the level of estrogen and excessive feeding of these feed materials is also found associated with increased incidence of the prolapse.
2. Low level of calcium: The low level of calcium in the diet is also associated with the high incidence of the prolapse because low level of calcium causes atony of the reproductive tract in pregnant animals leading to expulsion of reproductive organs with straining.
3. Increased intra-abdominal pressure: In the advanced pregnancy the increase intra-abdominal pressure is also a predisposing factor in occurrence of antepartum prolapse in buffaloes because this increased pressure causes more pressure on the flaccid and loosely attached structures like vagina leading to its expulsion outside the body.
4. Excessive deposition of fat: The excessive deposition of fat in the pelvic area perivaginally also increases the inrapelvic pressure and predisposes the animals to straining and prolapse.
5. Deficiency of micronutrients: It is also observed that deficiency of certain microelements like copper, iron, selenium, zinc is also associated with the occurrence of the prolapse in buffaloes.
6. Hereditary predisposition: The hereditary predisposition of the occurrence of prepartum prolapse is also observed in buffaloes in which the daughters of dams affected with prolapse are also having the problem related to prolapse.
7. More incidences in stall-fed animals: High incidence of prolapse is found to be associated with stall feeding as compared to managed farms. The exact reason is not known but is thought to be due to poor plane of nutrition in the animals which are stall fed as compared to the farm nutrition level. Close confinement of the animals in the stalls also causes problems in the animals.
8. Excessive feeding of dry fodder: High level of dry fodder like, wheat straw is also a predisposing factor which causes increased straining in the animals and prolapse of reproductive organs occurs.

Clinical signs and symptoms

            There can be different stages of prolapse of reproductive organs in the animals associated with the severity of occurrence.

1. Stage 1- In these cases the vaginal mucosa protrudes outside of the vulva when the animal is sitting or in recumbent condition but it goes inside when animal stands up.
2. Stage 2- The prolapsed mass remains visible outside the vulva when animal stands up but it only consists of vaginal mucosa.
3. Stage 3- Cervix along with vagina comes outside the vulva.

The cervicovaginal prolapse is most commonly encountered in the last trimester of pregnancy and protrusion may vary from mild to severe. The clinical signs associated with prolapse of vagina and cervix in buffaloes are:

• Straining.
• Prolapsed mass hanging outside the vulva.
• Edema of prolapsed mass.
• Retention of urine is most commonly associated with the prolapse and animal urinates in more amounts after repositioning of the organs inside.
• Animal becomes offed and lethargic.
• Breakdown of the cervical seal can lead to abortion.
• In unattended cases death may also occur due to necrosis of organs, septicemia and toxemia.

Consequences of antepartum cervicovaginal prolapse

            The occurrence of antepartum cervicovaginal prolapse in the buffaloes is associated with many consequences which can be:

• Flies sitting on the prolapsed mass invites the infection of the vagina and cervix causing continuous irritation and straining.
• Prolonged exposure of prolapsed mass can cause inflammation of the vagina and cervix and necrosis.
• Reoccurrence of prolapse can occur.
• Abortion.
• Death of animal can occur in unattended cases.
• Infection of genital tract may result in retention of placenta, cervicitis, metritis and infertility in some cases.
• Postpartum prolapse of uterus can also occur.

Management and treatment of cervicovaginal prolapse

            The aim of management and treatment of the animal suffering from the prolapse is to prevent the reoccurrence of the prolapse and to prevent further damage to the prolapsed mass. For the repositioning of the prolapsed organs inside the body three things to be kept in mind are:

1. Reduction in the size of the prolapsed mass: The prolapsed mass which is swollen due to edema is reduced in size by application of ice, cold water, alum salt and squeezing with a towel wrapped around the organs. The use of sugar for the reduction ion the size of prolapsed mass should be avoided because sugar will invite the flies and leads to infection.
2. Replacement of the prolapsed mass inside the body: The prolapsed mass should be cleaned properly with either fresh water or mixing 1:1000 KMnO₄ in the water. After washing the prolapsed mass, it should be smeared with the antiseptic ointment and then this mass is kept inside the body. While pushing the prolapsed mass inside the body it should be kept in the mind that hands should be clean and nails should be trimmed otherwise it can cause the injury to prolapsed mass and can lead to infection. Pressure should be applied with the palm first and the after introducing the part near to vulvar lips pressure must be applied with fist. It is better to avoid the use of fingers.
3. Retention of the prolapsed mass in the body: Different conservative and surgical methods are used to keep the prolapsed mass inside the body.
4. The conservative method of retaining the organ in the position includes the application of ‘Rope truss’ at the vulvar lips of the animal and the farmer should be able to check it when needed.
5. The surgical methods of retention are :      1. Buhner’s sutures

2. A. G. Teck profix button

3. Flessa sutures

4. Cervipexy/Winker’s technique

The supportive therapy which should be given to the animal after the repositioning of organs includes:  

1. Calcium therapy – 450 ml of calcium borogluconate should be administered slowly intravenously.
   1. Long acting antibiotics like Ceftiofur, Enrofloxacin, Oxytetracycline should be given to prevent occurrence of infection.
   1. Anti-inflammatory and analgesic drugs should be given to the animal to decrease pain and inflammation.
   1. Supportive therapy like antihistamines, vitamin-B complex and other antistress preparations should be given.
   1. The use of herbal medicines like castor oil for the smearing on the prolapsed mass after proper cleaning with the water. 100gms of fresh leaves of Abutilon indicum [Indian mallow], mildly fried in castor oil and macerated finely, administered orally once daily have shown good results in some animals.

Precautions to be adopted to control the occurrence of ante partum cervicovaginal prolapse and its management

1. Before buying the animal it should be kept in mind that animal should not have history of cervicovaginal prolapse.
2. It should be kept in mind that daughters of a dam previously suffering from prolapse should not be reared because it is hereditary in nature.
3. Proper plane of nutrition should be kept for the advanced pregnant animals as per the requirements.
4. There should be regular feeding of mineral mixture of good quality to the animals @ 2% of ration because deficiencies of different microelements is also found associated with the occurrence of the cervicovaginal prolapse.
5. The animal in the advanced pregnancy should be provided laxative diet to prevent impaction and straining.
6. Reduce the amount of total feed offered to animal when once the prolapse has occurred to prevent its reoccurrence.
7. Lift the hind limbs of the affected animal by means of inclined platform towards the rear portion of the animal.
8. Before replacing the prolapsed mass inside the body it should be properly washed with the water or non-irritant antiseptic solution.
9. Stop the feeding of suspected fodder like berseem, moldy maize or barley to the advanced pregnant animals at risk.

10. Provide the animals clean and adlib water to drink.
11. Provide as much as cool climate to the animals during summer. Heavy plantation around the farm, sprinkling water, bathing and roof painting will help to keep the animals cool and healthy in summer.

Nakul Gulia^1*, Amarjeet Bisla², Ashwani Kumar Singh³ and Mrigank Honparkhe⁴

¹Assistant Professor, ²Scientist, ³Professor, ⁴Principal Scientist-cum-Head (Email: nakul@gadvasu.in)

Department of Veterinary Gynaecology and Obstetrics, College of Veterinary Science (Ludhiana), Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana-141004, Punjab, India