Case Report Buffalo Bulletin (June 2015) Vol.34 No.

VAGINAL PROLAPSE IN PERI-PARTUM PRIMIPAROUS MURRAH BUFFALO

COMPLICATED INTO ENDOMETRITIS AND CYSTITIS: A CASE REPORT

Pankaj Kumar1,*, S. Dayal, Ramesh Tiwari1, Dipyaman Sengupta2, S.K. Barari and A. Dey

ABSTRACT prolapsed. In such condition, clinician should also

Buffaloes are unique in many ways
compared to other cattle in many aspects of
animal health. The reproductive performance
in buffalo is poor due to various diseases of the
reproductive system, including genital prolapsed.
Prepartum vaginal prolapse is one of the major
reproductive disorders in buffaloes. The presented
case report of a primiparous Murrah buffalo which
was affected with pre-partum vaginal prolapse
of low grade intensity which did not respond to
conventional therapy instituted and latter after
assisted parturition complicated into utero-vaginal
prolapse. After manual repositioning, infection
in the uterus resulted in puerperal metritis and
later urinary bladder infection. The condition
was not responding favorably to intrauterine and
systemic medication with suitable antibiotic, anti-
inflammatory and other supportive therapy. It
resolved only after antibiotic administration both
locally oxytetracycline hydrochloride (500mg tablet
Pfizer® dissolved in 60 ml pyrogen free water) into
the urinary bladder as well as systemic intravenous
infusion of broad spectrum antibiotic combination
of Ceftriazone 3000 mg and Tazobactam 375 mg
(Vetazo® Zydus Animal Health Limited) for 3 days.
The present case report signifies the possibility
of urinary bladder infection during utero-vaginal
1
Division of Livestock and Fisheries Management, ICAR Research Complex for Eastern Region, ICAR
Parisar, Patna, India, *E-mail: pankajvet@gmail.com
2
Department of Surgery and Radiology, Bihar Veterinary College, Patna, India
3
Department of Animal Reproduction, Gynaecology and Obstetrics, Bihar Veterinary College, Patna, India
look into possibility of urinary bladder involvement
and if left untreated results in delay in recovery due
to persistant straining originating from irritation in
the urinary bladder.
Keywords: primiparous buffalo, prolapse,
endometritis, cystitis
INTRODUCTION
Buffaloes are the backbone of milk
production in India, whose buffaloes account for
more than 55% of the world population. Buffaloes
are unique in many ways compared to other
cattle in many aspects of animal health (Azawi,
2010). The reproductive performance in buffalo
is poor due to various diseases of the reproductive
system, including genital prolapse (Rao and
Sreemannarayana, 1983; Akhtar et al., 2012).
Prepartum vaginal prolapse is one of the major
reproductive disorders in buffaloes (Azawi, 2010).
It mostly occurs in the seventh month of pregnancy
or later immediately after parturition (Sah and
Nakao, 2003). Etiologic factors of prepartum
vaginal prolapse in buffaloes may be attributed to
nutritional imbalance (Kelkar et al., 1989; Ahmed
et al., 2005), hormonal imbalance (Galhotra et al.,

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1991), seasonal-managemental factors (Mishra et
al., 1998; Gurcharan et al., 2003; Akhtar et al., 2010)
and hereditary predisposition (Nanda and Sharma,
1982). The hormonal changes that occur during this
last trimester of pregnancy, especially the increase
of estrogen and the production of relaxin, cause a
relaxation of the pelvic ligaments and surrounding
soft tissue structures (Wolfe, 2009). Prepartum
vaginal prolapse often terminate in uterine
prolapse post-partum resulting from the influence
of parturition. If infection is acquired, metritis or
pyometra may result. The present communication
reports a case of pre-partum vaginal prolapse
which complicated into uterine prolapse and finally
terminated in puerperal metritis-endometeritis and
urinary bladder infection.
CASE HISTORY AND CLINICAL
OBSERVATIONS
A Murrah buffalo aged about 3.5 years,
primaparous and in the last month of gestation,
was reported initially with the problem intermittent
prolapse of the vagina, with the vagina most
commonly protruding from between the vulva lips
when the animal was lying down while recumbent.
Vaginal prolapse later became aggravated in
the course with vaginal mass prolapsed during
standing posture while attempting to urinate or
defecate or strain. After 20 days, the entire vagina
prolapsed and clinical examination revealed
swollen, edematous and congested vaginal mucosa
with the visible cervix at the most caudal part of
the prolapse. Animal parturated on day 25 with
mild physical assistance during parturition and
gave birth to viable male calf weighing 35 kg. Thw
placenta (afterbirth) was discharged out without
any physical assistance in due course of time.
154
However, 4 days after parturition, straining resulted
in utero-vaginal prolapse. In time this resulted in
puerperal metritis and clinical endometeritis with
discharge of cream colour pus from the vagina
on rectal examination and massage of uterus.
On rectal examination of the reproductive tract,
the uterus was enlarged, flaccid, swollen and
fluctuating on palpation. The condition relapsed
even after manual repositioning and necessary
treatment provided. Severity increased when
buffalo attempted urination, defecation or lying
down recumbent. As the duration of the prolapse
increased, vascular compromise, trauma and fecal
contamination resulted in contamination of the
vaginal mucosa. The buffalo exhibited discomfort
manifest by straining and frequent attempts to
urinate and urine flow was turbulent (Figure 1 B).
Clinical examination revealed a slight tear (Figure
1 A, marked with an arrow) on the vaginal mucosa
near urethral opening with congestion, odema and
foul smell. The clinical examination of vital indices
revealed slightly elevated temperature ranging from
101.9°F to 103.2°F during the course of the day,
accelerated heart rate and respirations. Fresh urine
sample was examined using reagent strips (Q Dx
Urine Test 11 Nicholas®) for urinalysis, indicating
specific gravity 1.030, 2+ positive for leukocyte,
proteinuria (1+) and pH (7.5).
TREATMENTS AND DISCUSSION
During the first indication of low grade
vaginal prolapsed, the buffalo was treated with
sodium salt of 4-dimethylamino-2 methylphenyl-
phosphinic acid 0.2 gm (Tonophosphan® Vet
Intervet®) injection 15 ml IM for 3 days and
hydroxyprogesterone (Duraprogen® Vetcare®)
Injection 2 ml (0.50 gm) by IM route for 3 days.

The buffalo was also provided with rear elevation
support using straw bags. The animal showed signs
of improvement but vulvar lip closure was complete.
A decrease in progesterone concentrations has been
reported (Zicarelli, 2000) in buffaloes suffering
with vaginal prolapse. Successful progesterone
therapy in pre-partum vaginal prolapse in buffaloes
(Sah and Nakao, 2003) and cattle (Bhattacharyya
et al., 2012) has been reported indicative of the
role of low serum progesterone concentrations
in causing pre-partum vaginal prolapse. After 20
days of treatment prolapse recurred with higher
grade, showing prolapse of the vagina even when
animal was in standing position and straining was
moderate. No treatment was provided due to buffalo
nearing expected date of delivery. Only a rope truss
was applied for physical immobilization around the
vulva. Similar management of prepartum vaginal
prolapse using a rope truss has been reported by
Veeraiah and Srinivas (2010). Higher incidence
of genital prolapse was also observed in buffaloes
having more than 8 months of gestation by Patidar
et al. (2010). High incidence (around 43%) of
prolapse has been reported in buffaloes (Samad et
al., 1987). The buffalo gave birth to male calf after
25 days. Parturition was non-eventful except for
slight manual assistance provided for removal of
the calf. Follow up treatment was provided using
Chromostat® (Adrenochrome Monosemicarbazone,
Life Pharamceuticals) 25 ml IM as haemostatic
once, Lixen IU (Cephalexine) 60 ml intrauterine
for 3 days, Replanta® powder (Indian Herbs®)
50gm as commercial indigenous preparation for
uterine cleansing twice daily for 3 days, Melonex
plus® (meloxicam 5 mg and paracetamol 150 mg
per ml, Intas Pharmaceuticals®) as anti-pyretic
and analgesic 25 ml daily in two divided doses
for 3 days, strepto-penicllin Dicrysticin® 2.5 gm
(Sharabhia Zydus) given as systemic antibiotic once
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Buffalo Bulletin (June 2015) Vol.34 No.2
daily by IM route for 5 days. Sood et al. (2011) also
reported use of strepto-penicllin, meloxicam and
calcium borogluconate for managing postpartum
complications in buffalo. After 3 days of parturition,
the buffalo started showing severe straining and
this resulted in uterine proplase. Uterine prolapse
is more frequent in buffaloes in which vaginal
prolapse is observed during pregnancy, particularly
beyond the 7th month of gestation. Noakes et al.
(2001b) also observed maximum number of such
cases in the last 2 months of gestation. Forced
extraction of the fetus has also been incriminated
as an etiological factor (Noakes et al., 2001a). The
prolapsed mass was first washed with potassium
permanganate (1:1000) solution and urine was
discharged using sterile stainless steel catheter and
later the mass was manually repositioned and a
jute rope truss was applied around the vaginal lip.
Considering the possibility of contamination, the
buffalo was treated with a broad spectrum antibiotic
by the systemic route IM using Enrofloxacin
10% (Byrocin®, Bayer HealthCare) for 3 days
and provided with an indigenous preparation of
Prolapse-In (Cattle Remedies®) bolus 5 bolus twice
daily for 3 days orally. Calcium and phosphorus was
supplemented using intravenous slow infusion of
450 ml Mifex (Novartis®) once on the assumption
that hypocalcium may be one the factor for the
prolapse. Hypocalcaemia results in myometrial
fatigue and delays cervical involution (Murphy and
Dobson, 2002). There was appreciable improvement
initially with decrease in straining and discharge
of the placenta. However, again straining was
observed while urinating, urine was disrupted and
the animal tended to remain in urinating posture for
some time after urination (Figure 1 B). Straining
was suspected to result from infection of the uterus
resulting from contamination of the prolapsed mass
at the time of uterine prolapse and the systemic
Buffalo Bulletin (June 2015) Vol.34 No.2

A B

C D

E F

Figure 1. Buffalo suffering from vaginal prolapse, endometritis and cystitis before treatment (A, B, C and D)
and after treatment (E and F).

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antibiotic provided was not able to suppress the
infection. Discharge of pus on rectal examination
indicated development of clinical endometritis
(Figure 1 B, D). Raman and Bawa, (1977) also
reported a high prevalence of postpartum infections
(38.54%) in buffalo. Puerperal metritis treatment
was attempted by intra-uterine douching with 60
ml of 5% Lugol’s iodine on alternate days for 3
days along with anti-allergic pheniramine maleate
(Avilin®, Intervet India) 10 ml by IM route for
5 days and anti-inflammatory Melonex plus®
(Meloxicam 5mg and Paracetamol 150 mg per ml,
Intas Pharmaceuticals®) 25 ml daily in two divided
doses for 3 days. Lugol’s iodine is most commonly
used under field condition to treat endometritis.
Besides the antiseptic activity, Lugol’s iodine
causes local irritation of endometrium, releases
prostaglandin and regresses ovarian corpus luteum.
Postpartum metritis is one of the most important
disorders in buffaloes (Azawi et al., 2008), causing
high economic losses due to prolonged inter-
calving intervals and cost of treatment (Esslemont
and Peeler, 1993). The severity of condition
decreased with thicker consistency and lesser pus
discharge of rectal examination. The rope truss
was also removed. However straining continued
and endometritis persisted resulting in recurrent
prolapse. Suspecting the possibility of urinary tract
infection based on results of urine examination
and clinical symptoms, the buffalo was treated
with intra-urinary infusion of oxytetracycline
hydrochloride (500 mg tablet Pfizer® dissolved
in 60 ml pyrogen free water) into the urinary
bladder using sterile A.I. plastic sheet for 3 days
and systemic intravenous administration of broad
spectrum antibiotic combination of ceftriazone
3,000 mg and tazobactam 375 mg (Vetazo® Zydus
Animal Health Limited) for 3 days. Melonex
plus® (meloxicam 5 mg and paracetamol 150 mg
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Buffalo Bulletin (June 2015) Vol.34 No.2
per ml, Intas Pharmaceuticals®) 25 ml was also
administered by IM route daily in two divided doses
as supportive anti-inflammatory therapy for 3 days.
The buffalo responded well to this treatment and
straining decreased after 2 days of treatment with
proper urine flow and no pus discharge with uterine
tonicity was observed on rectal examination.
There was also improvement in the feed intake of
the animal and milk production (Figure 1 E, F).
The animal reportedly showed signs of heat 48
days after the last treatment and was successfully
inseminated.
ACKNOWLEDGMENT
The authors acknowledge the help provided
by Prakash Khatiwada, Technical staff of Animal
farm in carrying out the treatment and grateful
to the Head, Division of Livestock and Fisheries
Management and Director, ICAR RCER, Patna for
financial support and guidance.
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