International Journal of Veterinary Science

www.ijvets.com P-ISSN: 2304-3075 E-ISSN: 2305-4360 [email protected]

CASE REPORT

Manual Replacement of Bilateral Uterine Horn Prolapse Coupled With Retained Fetus in a
Great Dane Bitch
T Sathiamoorthy, Cecilia Joseph, P Sridevi and K Kulasekar

Department of Animal Reproduction, Gynaecology and Obstetrics, Madras Veterinary College, Chennai, India

ARTICLE INFO A B ST R A CT

Received: October 01, 2013 Uterine prolapse is a rare clinical condition in bitches. The determining factor in
Revised: October 15, 2013 choosing a method of treatment is whether or not the bitch is intended for
Accepted: November 13, 2013 breeding purpose in the future. The most suitable therapeutic approach for
uterine prolapse is surgery. In the present study manual replacement of uterus
Key words: and per vaginal delivery of retained fetus following replacement is reported. A
Bilateral uterine horn prolapsed Great Dane bitch was reported with the history of uterine prolapse following
Bitch whelping. Radiographic evaluation showed the presence of retained fetus which
Manual replacement was found to be non-viable on ultrasound examination. Based on the clinical
observations and the results of radiography and ultrasound the case was
diagnosed as complete uterine prolapse accompanied with retained fetus. Since,
the owner was interested in retaining the breeding potential of the dog, it was
decided to replace the uterus pervaginum. The prolapsed uterus was cleaned,
lubricated and both uterine horns were gently pushed into the vagina with
gloved fingers. Then by inserting hand into the vagina the uterine horns were
replaced in the abdominal cavity followed by a dead fetus was relieved
manually pervaginum. It is concluded that when the prolapsed uterus is neither
*Corresponding Author damaged nor necrosed and when it is necessary to retain the breeding potential
P Sridevi of the bitch, manual replacement without surgical removal can be adopted as
[email protected] the method of treatment.

Cite This Article as: Sathiamoorthy T, C Joseph, P Sridevi and K Kulasekar, 2013. Manual replacement of bilateral
uterine horn prolapse coupled with retained fetus in a great dane bitch. Inter J Vet Sci, 2(4): 125-127. www.ijvets.com

INTRODUCTION surgery, in particular when one uterine horn is fully

everted (Payan-Carreira et al., 2012). In the present study
Uterine prolapse is a rare clinical condition in bitches since the owner wanted to retain the breeding capacity of
with a reported incidence of <0.03% (Wood, 1986). It can the bitch manual replacement of uterus and per vaginal
happen in first pregnancy, but is most likely after a bitch delivery of retained fetus following replacement is
has had several litters, with or without complications. The reported.
condition occurs due to prolonged labor, up to 48 hours
after whelping, when the cervix is extremely dilated and CASE HISTORY AND OBSERVATIONS
may involve single or both uterine horns. Other possible
causes include prolonged dystocia, oversized fetus, A six year old Great Dane bitch weighing 46 kgs was
multiple pregnancies, laxity of uterine ligaments, brought to the small animal gynaecology unit of Madras
excessive abdominal contractions, uterine atony and Veterinary College Teaching Hospital with the history of
placental detachment (Wood, 1986). In the uterine sudden Expulsion of large reddish mass from the vulva.
prolapse, a uterine segment passes through the cervix and The bitch had whelped five healthy pups the previous
vagina, when the cervix is relaxed, and protrudes at the night with the last pup delivered two hours before. Owner
vulva, in variable extension (Davidson, 2009). Severity of reported that after the birth of the last pup the placenta
the clinical signs and prognosis depend on the duration of was coming out when the bitch suddenly pulled the
the prolapse. The determining factor in choosing a method placenta with its teeth and ingested the placenta. Forceful
of treatment is whether or not the bitch is intended for removal of the placenta was followed by severe vaginal
breeding purpose in the future (Agaoglu et al., 2012). The bleeding after which the prolapse of the uterus was
most suitable therapeutic approach for uterine prolapse is noticed by the owner.

125
 126 Inter J Vet Sci, 2013, 2(4): 125-127.

General examination of the bitch revealed that the

body condition was optimum and the bitch was in
standing posture and not straining. The temperature, heart
rate and pulse rate were within the physiological limit.
Examination of vulva revealed the prolapse of both horns
of uterus (Fig. 1). The mass was protruding out about 6
cm from the base of the vulva. Motility of the uterus was
visualized. The mass was slightly swollen and congested
with no evidence of lacerations, necrosis and tear (Fig.2).
Radiographic evaluation showed the presence of retained
fetus which was found to be non-viable. Based on the
clinical observations and the results of radiography and
ultrasound the case was diagnosed as complete uterine
prolapse accompanied with retained fetus. Fig. 1: Uterine prolapsed

TREATMENT AND DISCUSSION

Since, the owner was interested in retaining the

breeding potential of the dog, it was decided to replace the
uterus pervaginum. The prolapsed uterus was cleaned
with normal saline and hypertonic saline solution (25%
dextrose) was poured over the prolapsed mass to reduce
the swelling. The uterus was lubricated with antiseptic
cream (Cetrimide) and both uterine horns were gently
pushed into the vagina with gloved fingers. Then by
inserting hand into the vagina the uterine horns were
replaced in the abdominal cavity following which careful
examination was done to locate the retained fetus. A dead,
immature and under sized fetus was relieved manually Fig. 2: Swelling and congestion of right uterine horn
pervaginum (Fig.3). The bitch was treated with
intravenous fluids and antibiotics and the bitch became
normal and quite active. Pups were allowed to nurse the
bitch and it was discharged on the same day. No further
complications were reported by the owner and the bitch
recovered uneventfully.
Uterine prolapse is seldom diagnosed in dogs, in
particular when associated with parturition, when
compared to other species (Johnson, 1989). More often it
takes place right after the expulsion of foetuses, but it may
also occur in association with the expulsion of one of the
foetus, when it may be at the origin of maternal dystocia
because of obstruction of the vaginal vault. In the present
case the uterine prolapse occurred even when one fetus Fig. 3: Retained fetus delivered pervaginum
was still present inside the uterus. Excessive expulsive
efforts and oversized foetus are frequent causative factors. differentiated from true vaginal prolapse or vaginal or
The other most common causes for the occurrence of uterine neoplasm. The mass should be thoroughly
uterine prolapsed in bitches are the tenesmus, inappropriate examined for the presence of rupture and eventual
obstetrical technique, such as a faulty administration of haemorrhage (Payan-Carreira et al., 2012). The uterine
oxytocin or excessive force during manual intervention tissue may be ischaemic or necrotic, depending on the
(Hedlund, 2007; Reichler and Michel, 2009). Partial or total duration of the prolapse. The clinical signs are largely
uterine prolapse is relatively less common in the bitch than dependent on the degree of the prolapse or the extent of
in the queen. Darvelid and Linde-Forsberg (1994) the rupture, the existence of haemorrhage, the
reported not even a single case of uterine prolapse after contamination of the abdominal cavity with uterine and
analysing 182 obstetrical conditions in bitches. foetal fluids, or the retention of a foetus in the uterus
No particular age and breed predisposition was (Payan-Carreira et al., 2012). In the present case only
recorded with the incidence of uterine prolapse in bitches. slight swelling and congestion of the uterine horns was
Johnson (1989) reported that uterine prolapse occured in noticed.
bitches of varying ages and breeds, and in primiparous or As uterine prolapse occurring early in parturition
multiparous females. could impair its normal progress, and may promote foetal
For a successful treatment, early and correct retention with posterior maceration. If uterine rupture
diagnosis was important, as uterine prolapse can produce coexists, the foetus may escape into the abdominal cavity
a life threatening situation in the event of severe bleeding resulting in posterior peritonitis or granuloma formation.
into the abdominal cavity. The prolapsed mass should be Hence, it is important to ascertain the presence of foetus
 127 Inter J Vet Sci, 2013, 2(4): 125-127.

in the uterus and the patency of the birth canal (Payan- REFERENCES
Carreira et al., 2012). In this case one immature and
under sized fetus was retained due to fact that uterine Agaoglu AR, M Kocamuftuoglu, Y Cetin and MT Celik,
prolapse was only partial. Retained fetus was relieved by 2012. Uterine prolapse in a Pointer bitch. Eurasian J
inserting the hand into the uterus since it was large sized Vet Sci, 28: 182-184.
Great Dane female with a large pelvic inlet permitting the Darvelid AW and C Linde-Forsberg, 1994. Dystocia in
hand of the veterinarian to pass into the uterus. The the bitch: A retrospective study of 182 cases. J Small
determining factor in choosing a method of treatment is Anim Pract., 35: 402-407.
whether or not the bitch is intended for breeding purposes Davidson A, 2009. Postpartum disorders in the bitch and
in the future (Agaoglu et al., 2012). The most suitable queen. 81st Annual Western Veterinary Conference.
therapeutic approach for uterine prolapse is surgery, in Las Vegas, NV, USA, p: 239.
particular when one uterine horn is fully everted (Payan- Hedlund CS, 2007. Surgery of the reproductive and
Carreira et al., 2012). In the present case, since the genital systems. In: Small Animal Surgery, 3rd
prolapsed uterus had no lacerations, necrosis and looked edition, Eds. Fossum TW, CS Hedlund, AL Johnson,
relatively fresh and also the owner wanted to retain the KS Schulz, HB Seim, MD Willard, A Bahr, GL
breeding capacity of the bitch it was decided to manually Carroll, Elsevier Mosby, St. Louis, Missouri, pp: 702-
replace the uterus and not resort to surgical intervention. 774.
Hence, it is concluded that the uterine prolapse in the Johnson CA, (1989): Uterine diseases. In: Ettinger SJ and
present case might have occurred due to the sudden EC Feldman (eds.), Textbook of Veterinary Internal
traction given by the bitch while removing the placenta Medicine: Diseases of the Dog and Cat, 2nd edn.
from the birth canal. Further, when the prolapsed uterus is W.B. Saunders, Philadelphia, pp: 1797-1805.
neither damaged nor necrosed and when it is necessary to Payan-Carreira R, C Albuquerque, H Abreu and L Maltez,
retain the breeding potential of the bitch, manual 2012. Uterine prolapse with associated rupture in a
replacement without surgical removal can be adopted as Podengo Bitch. Reprod Domest Anim, 57: 51-55.
the method of treatment. Reichler IM and E Michel, 2009. Dystocia: recognition
and management. EJCAP, 19: 165-173.
Acknowledgment Wood DS, 1986. Canine uterine prolapse. In: Current
The Authors are thankful to the Professor and Head, Therapy in Theriogenology: Diagnosis, Treatment,
Department of Clinics, Madras Veterinary College, and Prevention of Reproductive Diseases in Small
Chennai-600 007, India for the facilities provided to and Large Animals, 2nd edition, Ed: Morrow DA,
conduct the present study. WB. Saunders, Philadelphia, pp: 510-511.