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Induction of parturition for management of cervico-vaginal prolapse in a ewe.

Introduction

Cervico-vaginal prolapse is a condition of ruminants, normally in late gestation. Sometimes it is seen after parturition and rarely does it occur unconnected with pregnancy and parturition. It is recognised by protrusion of vaginal wall and sometimes cervix through the vulva exposing the vaginal mucosa. It is more common in sheep than in any other species. Incidence of Cervico vaginal prolapse in sheep is as low as 0.5-1% in a flock and as high as 20-40%. Cervico-vaginal prolapse is of utmost economic importance because it can cause abortion, infertility, still births, dystocia and sometimes death of ewe.

History and Clinical findings

A pregnant ewe with history of mass protruding from the vulva was presented for treatment. She was approximately three years of age and in second parity. The body condition of ewe was poor and stall fed. According to the owner and based on the date of breeding, 120 days of pregnancy was estimated. The owner had noticed this condition since two days, although a mass vaginal protruding was observed since last two weak when the ewe was recumbent and would disappear when the ewe stood.

On physical examination, identified as the mass protruding was vaginal mucous membrane. On careful examination, prolapse of cervix was also noticed along with vaginal prolapse. The prolapsed vaginal mucose membrane was devoid of ulcers or lacerations (Fig. 1).

Ultrasound examination was done to know the contents of prolapsed vagina. Neither bladder nor intestines were detected in prolapsed mass. The case was diagnosed as cervico-vaginal prolapse. The status of pregnancy was evaluated by using ultrasonography, which revealed presence of viable multiple fetuses.

Treatment

The replacement and retention of prolapsed vagina was carried out. The procedure was performed under caudal epidural anaesthesia. The injection was made into first coccygeal interspace using 2 percent lidocaine hydrochloride with adrenaline @ 1ml/50 kg body weight. The prolapsed mass was washed with potassium permanganate solution. Oedema was reduced using cold water. Under aspetic conditions, prolapsed vaginal mass was replaced back into vaginal cavity. For retention of prolapsed mass in its position Buhner's suture was applied. After retention of sutures for 10 days, on 130th day of pregnancy sutures were removed. Around 140th day of gestation prolapse of vagina was observed again, but cervix was not visible. Around 144th day of gestation the condition progressed to stage 3, with severe straining. Since the straining was heavy and pregnancy was already in 20th week, it was decided to induce parturition.

Parturition was induced using dexamethasone at 15mg total dose. The ewe was under constant observation for signs of delivery. Around 22 hours after induction slight mucus discharge was observed. Around 25 hours, ewe was found in severe discomfort and water bag was visible in between the vulval lips (Fig. 2). In the vagina foetal parts were palpated. The ewe was assisted for parturition with 3 live lambs (Fig. 3).

Discussion

The predisposing factors for cervico-vaginal prolapse in this case could be presence of multiple foetuses, inadequate exercise due to stall feeding and poor body condition of animal. Cervicovaginal prolapse is reported to occur in the last 23 weeks of gestation (Roberts, 1982; Noakes et al., 2009) as observed. Replacement and retention of prolapse was done to prevent trauma and to ensure ewe maintain pregnancy to term Buhner'suture was removed on 130 days of pregnancy as the vulva had begun to lacerate. The prolapse recurred after ten days of removal of Buhner'suture. This time severity of prolapse was high and intensity of abdominal contractions were severe. Since there are reports in sheep that severe prolapse with heavy straining is not tolerated well and fatalities from shock, exhaustion and aerobic infection can occur (Noakes et al., 2009), also as it is noted that 56 percent of ewe with cervico-vaginal prolapse end up with dystocia of which 70 percent are due to incomplete dilation of cervix. It was decided to induce parturition and assist in delivery of ewe.

Corticosteroids when used for induction are found to induce parturition in 2-5 days time. In this case impending signs of parturition were observed in 22 hours of induction and process of delivery completed by 25hours with assistance. Although delivery of dead foetus are reported in ewes with cervico-vaginal prolapse, in this case since parturition was induced at the appropriate time and the ewe was assisted in parturition, three viable lambs were delivered. In the follow up after two weeks all three lambs were alive and gaining weight. Ewe showed no signs of recurrence of prolapse.

References

Roberts, S J. (1982). Veterinary Obstetrics and Genital Diseases. 2nd edition. CBS Publishers and Distributers Pvt Ltd., p.189-95.

Noakes, E. David, Timothy, J. Parkinson and Gary, C. W. England (2009). Veterinary Reprodction and Obstetrics. 9th Edition. Saunders Elsevier Publication. 148-149.

Yugandhar Manvi, G. Sudha (1) and A. Krishnaswamy (2)

Department of Veterinary Gynecology and Obstetrics Veterinary College Karnataka Veterinary Animal and Fisheries Sciences University (KVAFSU) Hebbal Bengaluru--560024 (Karnataka)

(1.) Assistant Professor and Corresponding author. E-mail: dinaditi@rediffmail.com

(2.) Professor
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Title Annotation:Clinical Article
Author:Manvi, Yugandhar; Sudha, G.; Krishnaswamy, A.
Publication:Intas Polivet
Article Type:Report
Geographic Code:9INDI
Date:Jul 1, 2014
Words:832
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