Uterine prolapse is one of the true emergencies in food animal veterinary medicine.
This condition is relatively rare. Estimates suggest that approximately two cows in every 1,000 calvings will have a uterine prolapse. However, it is a serious life-threatening condition for the animal and prompt action is required.
If the cow is straining badly after calving or if the uterus is very flaccid, the cow may push the uterus through the birth canal, inside-out. This large solid mass of tissue with two to three-inch inch long “buttons” on the surface, where the membranes attach, is the uterus or calf bed inside out.
Read Also
The Western Producer Livestock Report – August 28, 2025
Western Producer Livestock Report for August 28, 2025. See U.S. & Canadian hog prices, Canadian bison & lamb market data and sales insights.
Any age of calving cow can be affected. Heifers that prolapse usually do so because of prolonged straining in a difficult calving. Older cows may also prolapse due to calving difficulties and some may also prolapse because of low calcium levels (milk fever).
Low levels of calcium have a detrimental effect on muscle tone and will make the uterus flaccid and more likely to prolapse. Dairy cows are more prone to milk fever and therefore more susceptible to uterine prolapses.
The uterus of a recently calved cow is a large, muscular organ so diagnosis of prolapse is not difficult. However, prompt action is needed to maximize the likelihood of cow survival.
When the uterus is first exposed, the tissues will appear fairly normal but in a short time the tissues will swell and become dark red or purple.
As fluid accumulates in the uterine tissues, they become much more fragile and easily damaged. The sooner the prolapse can be replaced, the less tissue damage will occur.
The first step is to restrain the animal. In many cases, because the cow is already in shock, it is reluctant to stand and move. Cows that are able to stand should be slowly and quietly restrained in as calm a manner as possible.
The uterine artery is a very large blood vessel that is the main route of blood supply to the uterus. If a cow with a prolapse moves around excessively or runs, the artery can be stretched and rupture. The cow will then bleed to death.
Wherever possible, restrain the cow quietly without moving her. Remove other animals from the area so they don’t step on the uterus or damage it. If veterinary assistance will be delayed, cover the uterus with a clean, moist towel and if it is very cold out, protect the tissues from freezing with an insulating blanket.
To replace this organ, the veterinarian will have to administer an epidural anesthetic to prevent the cow from pushing. The uterus will need to be carefully cleaned with warm, soapy water and all manure and bedding removed from the surface.
If the placenta is still attached, it can often be peeled off gently from the cotyledons or “buttons”. If there are any significant tears in the uterus, they must be repaired prior to replacement.
The veterinarian will attempt to put the uterus back into the cow. This is not always an easy task. The cow will still strain despite the epidural, and it sometimes seems this huge mass of tissue will never fit back in.
If the cow is lying down, the veterinarian may have the hind legs extended in a “frog-legged” position to help with positioning the pelvis. The veterinarian may need an assistant to help hold this large organ and keep it clean. Everyone needs to be as clean as possible to minimize contamination of the uterus.
It is very important to ensure the prolapse is completely replaced in the normal position. If even a small portion of a uterine horn remains inverted, the cow may prolapse again. Many veterinarians will place sutures to help prevent the prolapse from reoccurring, although this is not always necessary.
Cows are usually given oxytocin to contract the uterus after it is replaced and are often given antibiotics to prevent infection. If milk fever is also an issue, intravenous calcium should be administered.
The prognosis is usually good if the prolapse is replaced quickly and the uterus has not been severely damaged or the uterine artery has not ruptured.
The fertility of cows that suffered a uterine prolapse is reduced. However, cows will not necessarily have a uterine prolapse in subsequent calvings, and may not need to be culled.
John Campbell is a professor in the department of Large Animal Clinical Sciences at the University of Saskatchewan’s Western College of Veterinary Medicine.
