Uterine prolapse can occur after fetal delivery as a result of dystocia or exhaustive uterine inertia. This is an emergency
situation and should be corrected immediately. In this case, the uterus everts out through the vulva, placing tremendous strain
on the middle uterine arteries, exposing the endometrium to the environment and during the cold season, the dam can lose significant
amounts of body heat through the uterus. The dam should be handled as carefully as possible and not allowed to travel. It
is common for the weight of the uterus to break the uterine arteries, causing the dam to bleed out into her abdomen. It is
best to have the dam in the cushed position for replacement. A lidocaine caudal epidural should be given and the uterus washed
and disinfected thoroughly. The veterinarian should kneel behind the dam and, starting near the vulva, begin to replace the
uterus. It is important to use your hands in "fists" or with your fingers folded, rather than using your extended fingers
to push. Prolapsed, post-partum uteruses are very friable and easy to puncture. Once the uterus has been replaced, time should
be spent to make sure it is fully extended back to its normal conformation. A pursestring suture should be placed temporarily
(3-5 days) in the vulva and I recommend that oxytocin, fluids, calcium and systemic antibiotics be given.
One of the most common situations we are presented with is the "overdue" dam. This is a cause for great concern to owners,
who often wish to have parturition induced. In this situation, a complete physical exam, rectal exam and vaginal exam with
an epidural should be performed. Rectal exam is best performed by placing 60-100mL of lube into the rectum and then gently
entering with a lubed, sleeved hand. If available, transabdominal ultrasound can be used to assess fetal heart rate, with
normal being 90-120 bpm (about 1.5-2x the maternal heart rate). When the fetal heart is <60 bpm over serial measurements,
intervention should be considered. As a rule, we do not recommend induction of parturition where the life of the cria is to
be spared. Induction of parturition in an "overdue" dam, in my experience, almost always results in a premature or dysmature
fetus with poor survival rates.
Another common request is to hospitalize expectant dams to monitor for parturition. This change in environment, in our experience
with this species, increases the likelihood of uterine torsion, incomplete cervical dilation, and premature placental separation.
References available upon request