The diameter of a vaginal
prolapse varies from an area of dorsal vaginal wall of
approximately 8 cm up to 20 cm when the prolapse may contain
urinary bladder, uterine horn(s) or both of these
Fig 1: A vaginal
prolapse extending for 10-12 cm.
Fig 2: The
diameter of this vaginal prolapse extends to 20 cm and contains the
during the last month of
typically affects around 1
per cent of pregnant sheep
but the prevalence varies
from zero to 15 per cent
Many factors have
been implicated in the cause of vaginal prolapse
excessive body condition
(body condition score 4 and above; scale 1 to 5),
(triplets more than twins)
high fibre diets
particularly those containing root crops,
limited exercise in housed
lameness leading to
prolonged periods in sternal recumbency,
Short-docked tails (this ewe) have been implicated in vaginal
Ewes with vaginal prolapse
may show many behavioural signs consistent with first stage labour
isolation from the
remainder of the flock,
failure to come forward for
long periods spent in
lateral recumbency with repeated, short duration, forceful
abdominal contractions and associated vocalisation.
Fig 4: Ewe
straining with a vaginal prolapse with behaviour consistent with
first stage labour
The duration of prolapse
the degree of contamination
with faeces, bedding material and soil,
the friability of the
The vaginal wall quickly
becomes swollen and friable greatly increasing the risk of rupture
during manual replacement.
Treatment of vaginal
If it is necessary to
transport sheep with vaginal prolapse to the veterinary surgery
then the prolapse should be covered with a towel soaked in warm
water to prevent further damage.
Effective caudal analgesia
administered by a veterinary surgeon greatly facilitates
replacement of the vaginal prolapse. Emptying of the bladder can
then be readily achieved in the standing ewe by raising the
prolapse relative to the vulva thereby reducing the fold in the
neck of the bladder at which point urine flows freely.
Fig 5: The
prolapse should be carefully cleaned in warm water containing
surgical scrub solution.
The vaginal prolapse should
be replaced with the ewe standing, indeed the vaginal prolapse will
frequently return to the normal position within five minutes once
caudal analgesia has been effected, and straining ceased. There are
no indications to suspend the ewe by the pelvic limbs.
Administration of local anaesthetic to block straining by the
An analgesic drug will be
administered intravenously by the veterinary practitioner before
replacing the vaginal prolapse to reduce pain. Antibiotics should
be given daily for three to five days afterwards; penicillin is
cheap and effective. Alternatively, a long acting antibiotic such
as oxytetracycline can be administered.
Methods of retention
after replacement of vaginal prolapse
Methods of retention after
replacement of vaginal prolapse include:
A modified Buhner suture of 5
mm nylon tape is placed by the veterinary practitioner in the
subcutaneous tissue around the vulva 2 cm from the labia and
tightened to allow an opening of 1.5 cm diameter (two fingers). The
modified Buhner suture can easily be untied to allow examination of
the posterior reproductive tract for signs of first stage
Fig 7: Pain-free insertion of a Buhner suture using
Fig 8: Buhner
suture is tightened to allow an opening of 1.5 cm diameter (one-two
Fig 9: The
Buhner suture must be slackened before the expected lambing date.
Note the allanto-chorion indicating the end of first stage labour
in this ewe.
Sutures which penetrate the
vaginal mucosa, such as single interrupted or mattress sutures,
must be avoided as urine scalding of vaginal mucosa around the
suture material in conjunction with secondary bacterial infection
forms large diphtheritic areas which cause considerable discomfort
and resultant straining. Furthermore, single interrupted and
mattress sutures must be removed to permit digital examination of
the ewe's posterior reproductive tract during periods of suspected
first stage labour, and cannot easily be re-tied.
All ewes with retention
sutures for vaginal prolapse must be clearly identified and staff
notified that there could be problems at lambing with this group of
sheep. Permanent ewe identification is essential to ensure culling
before the next breeding season.
Plastic retention devices
Plastic retention devices are
shaped such that the central loop is placed within the vagina which
is then held within the pelvic canal by the two side arms tightly
tied to the fleece of the flanks. These devices can work well in
mild early cases.
Fig 10: Plastic
retention devices can work well in mild early
Fig 11: The
plastic retention device is not working in this case - effective
analgesia is essential in this case and could be provided by
extradural injection and intravenous NSAID
Harnesses or trusses
Effective management of a vaginal prolapse in a Blueface Leicester
ewe using a truss.
Harnesses and trusses are
very useful in situations where the prolapse is detected early and
there is little superficial trauma/contamination. Harnesses and
trusses must be fitted carefully, and inspected regularly, to
prevent pressure sores.
The Buhner suture should be
untied well before the expected lambing date.
Impending lambing can be estimated
Signs of first stage labour
separation from the remainder of the group,
frequent getting up and lying down,
sniffing at the ground, and abdominal straining
membranes present at the vulva.
If the cervix has already
fully dilated, and first stage labour completed, a lamb may be
forcefully expelled as soon as the retention suture has been
Complications as a consequence of vaginal
Complications as a
consequence of vaginal prolapse include:
Many shepherds only present
vaginal prolapses for veterinary attention when other methods have
Abortion may occur 24 to 48
hours after replacement of the vaginal prolapse. It is not known
whether this event is a consequence of trauma to the placenta
during prolapse or other factors. Ewes must be confined and
carefully supervised after replacement of prolapses for signs of
Incomplete cervical dilation
superficial infection and oedema of the vaginal prolapse at the
time of replacement may result in incomplete cervical dilation
during first stage labour.
Considerable trauma and oedema of the vaginal prolapse at the time
of replacement may result in incomplete cervical dilation during
first stage labour.
Death of ewe
Death of lambs which are not
expelled may cause death of the ewe.
Fig 14: Death of lambs which were not expelled
causing death of this ewe. Note the very distended (gas-filled)
uterus containing emphysematous (rotten) lambs.
Uterine prolapse occurs at a
rate of approximately 0.1% of ewes at risk.
Fig 15: Uterine
Uterine prolapse may occur
either immediately after lambing or after an interval of 12 to 48
hours. In the first instance prolapse usually results as
consequence of prolonged second stage labour culminating with the
delivery of a large singleton lamb (see above). Uterine prolapse
occurring after an interval of 12 to 48 hours generally results
from straining caused by pain arising from infection and swelling
of the posterior reproductive tract (see below) which have
developed consequent to assisted delivery of the
Fig 16: Uterine
prolapse occurring 48 hours after an assisted lambing Straining
caused by pain from infection and swelling of the posterior
reproductive tract caused the prolapse.
The everted uterus is readily
identifiable by its large size (up to 50 cms long and 25 cms in
diameter) extending from the vulva to below the level of the hocks
with prominent caruncles and adherent foetal membranes.
The uterus is readily
Unless the uterus is replaced
correctly and fully inverted to its normal position within the
abdomen, the ewe will continue to strain causing considerable
distress and suffering, and re-prolapse. A uterine prolapse is best
replaced by a veterinary surgeon under extradural
Successful replacement of the uterine prolapse featured in the
Infiltration of the vulva
with 2 per cent lignocaine solution affords some degree of
analgesia in order to insert retention sutures but this technique
is much inferior to caudal block. A Buhner suture of 5mm umbilical
tape affords the best means of retaining the uterus (see method for
retention of vaginal prolapse above). Antibiotics, either procaine
penicillin or oxytetracycline, should be administered
intramuscularly daily for three to five consecutive days after
replacement of the uterine prolapse to limit bacterial infection of
the traumatised tissues and NSAIDs to reduce pain. The ewe's milk
yield will be reduced for a number of days after replacement of the
uterine prolapse and her lambs will require supplementary feeding.
Unlike vaginal prolapse, it is unusual for an ewe to prolapse the
uterus the following year thus there is no indication to
prematurely cull such ewes.
Antibiotics should be
administered intramuscularly daily for three to five consecutive
days after replacement
NSAIDs to reduce
Fresh food and ad-libitum
clean water to promote milk yield
Supplementary feeding of
the lambs for several days
Evisceration through vaginal
Evisceration of intestines
through a tear in the dorsal vaginal wall occurs spontaneously in
heavily pregnant ewes during the last month of
Evisceration of intestines through a tear in the dorsal vaginal
There is usually no history
of prior vaginal prolapse or straining. The incidence may reach 2
to 5 per cent in some housed flocks. Excessive body condition,
triplet pregnancy, and high fibre diets are thought to be risk
factors but the precise mechanism is not known.
There is no treatment and
affected ewes must be destroyed immediately for welfare reasons. If
the ewe is due to lamb within three days the ewe could be shot and
an emergency caesarean operation undertaken to salvage the lambs
however this procedure is rarely successful. Furthermore, when
evisceration occurs during late gestation in flocks lambing over a
concentrated period there are no ewes to accept such weakly foster