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Uterine prolapse
Uterine prolapse is the complete inversion of the uterus, which exits through the vulva and hangs behind the cow as a large red mass, often down to the hocks. It almost always occurs in the hours following calving, more rarely in the follow...
What is it?
Uterine prolapse is the complete inversion of the uterus, which exits through the vulva and hangs behind the cow as a large red mass, often down to the hocks. It almost always occurs in the hours following calving, more rarely in the following days.
It is one of the most serious emergencies in cattle farming. The extruded uterus is engorged with blood: it can tear, bleed massively or lead to fatal shock within a few hours.
The rule is simple and without exception: call the veterinarian immediately, never attempt to put the uterus back in place yourself, and keep the cow calm and lying down while waiting.
Key point
Absolute life-threatening emergency. Call the veterinarian immediately, never put the uterus back on yourself, keep the cow calm and lying down.
Commonly observed signs
These signs are neither exhaustive nor specific. Only a veterinarian can establish a diagnosis.
Related signs — each one links to its page:
Large, red to dark red mass, emerging from the vulva and hanging behind the cow. Its surface has characteristic rounded reliefs, corresponding to the attachment points of the placenta.
The mass quickly becomes dirty with earth, straw and dung, and swells as time passes.
The cow pushes, agitates, shows signs of pain, trembles.
She is often lying down and unable to get up, particularly when a lack of calcium is associated.
Pale mucous membranes, rapid breathing, cold extremities: these are the signs of shock and hemorrhage.
Rapid depression, fixed gaze, refusal of any food.
When to consult without delay
This list does not replace veterinary advice. It gathers situations that justify a prompt consultation.
Causes and risk factors
The uterus turns on itself because it remains flaccid after calving and the cow continues to grow.
The lack of calcium around birth, the cause of milk fever, is the best identified contributing cause: the muscles, including those of the uterus, no longer contract properly.
Difficult calving, strong traction on the calf, rapid extraction or a very large calf increase the risk.
A retained placenta that causes the cow to push repeatedly can trigger turning.
Cows that are very emaciated or in poor general condition are more exposed.
Milk fever and calcium deficiency around calving.
Difficult calving, excessive traction, large calf, twins.
Placental retention and prolonged pushing efforts.
Old, multiparous cows, in poor body condition.
Slippery ground or pronounced slope at the rear of the housing, which favors pushing efforts.
Mineral deficiencies in the late gestation ration.
Diagnosis and care
Diagnosis is the veterinarian's responsibility, based on clinical examination and laboratory tests. Care is decided case by case.
The intervention is veterinary and urgent. While waiting for its arrival, your role is to limit the damage: isolate the cow in a quiet area, prevent it from getting up and walking, keep other animals away.
Keep the uterus clean and moist: place a clean sheet or towel on it, moistened with clean water. Gently raise the mass at the level of the vulva, without pulling, to limit engorgement.
Do not put any concentrated disinfectant product, sugar, soil or soiled leaves on the organ.
On arrival, the veterinarian installs the cow, performs anesthesia which eliminates the pushing efforts, cleans the uterus, unclogs it, then puts it back in place completely, all the way to the bottom.
He then checks for tears and bleeding, often places retaining stitches in the vulva, and treats the lack of calcium as well as the risk of infection.
Treatment
Repositioning is a technical act that requires anesthesia, strength, clean equipment and experience. Any attempt by an untrained person worsens the situation: tearing of the uterus, internal bleeding, infection, death of the cow.
The veterinarian completes the procedure with supportive treatment: calcium infusion when milk fever is the cause, rehydration, anti-inflammatories and antibiotics depending on the cow's condition.
Monitoring over the following days is essential: risk of metritis, recurrence, retained placenta.
If the cow is too affected or the uterus too damaged, the veterinarian may need to discuss other options with the breeder.
As with any treatment, the waiting period for milk and meat set by the veterinarian must be respected in full.
Treatment depends on the cause and the animal's condition: it must be determined by a veterinarian. No self-medication.
Prevention
Prevent milk fever: adapted dry-off ration, management of calcium and minerals at the end of gestation according to the veterinarian's advice.
Limit difficult calvings: choice of bulls for ease of calving, monitoring of births, measured and never brutal intervention.
Do not pull the calf too quickly: give the uterus time to retract.
Monitor the cow during the hours after calving, when almost all prolapses occur.
Ensure non-slippery ground and a flat, well-mulched calving area.
Quickly treat retained placentas that cause the cow to grow.
Maintain cows in good body condition before calving.
Possible complications
Massive hemorrhage due to rupture of the vessels of the uterus: this is the quickest cause of death.
Shock and death within a few hours.
Tearing of the uterus, sometimes with exit of intestinal loops: extremely serious situation.
Metritis and generalized infection in the days that follow.
Recurrence of prolapse after replacement.
Subsequent infertility when the uterus has been very damaged.
When to see a veterinarian
A red mass comes out of your cow's vulva after calving: call the veterinarian immediately, at any time.
Never try to put the uterus back in yourself or pull on anything.
Prevent the cow from getting up and moving around, keep her calm and lying down.
Cover the organ with a clean, damp cloth until the veterinarian arrives.
If the cow is very pale, breathing quickly or no longer reacts, report this to the veterinarian as soon as you call: this is a sign of shock.
Also report if the cow was already not getting up before the prolapse: this indicates an associated milk fever.
Prognosis
When the veterinarian intervenes quickly, before the uterus becomes too engorged or soiled, the majority of cows survive and many become pregnant again.
The prognosis deteriorates with the passage of time: each hour increases engorgement, contamination and the risk of hemorrhage.
Cows in a state of shock at the time of the intervention have a guarded prognosis despite treatment.
A recurrence at the next calving remains possible, which justifies close monitoring of subsequent births.
Frequently asked questions
Can I put the uterus back in place while waiting for the vet?
No, never. Without anesthesia the cow pushes and the organ comes out; without suitable technique the uterus tears and the cow can die from hemorrhage. Keep her lying down and calm, cover the organ with a clean, damp cloth, and call immediately.
Should the cow be made to stand up?
No. A cow that stands up and walks increases engorgement and the risk of rupture. Keep her lying down, in a clean, quiet place, until the veterinarian arrives.
Is this the same as vaginal prolapse before calving?
No. Vaginal prolapse occurs especially at the end of gestation, the mass is smaller and smoother. Uterine prolapse occurs after calving, the mass is much larger and has rounded reliefs. Both warrant a call to the veterinarian, but uterine prolapse is an immediate life-threatening emergency.
Will my cow still be able to have calves?
Often yes, if the intervention was quick and without tearing. Future fertility depends on the condition of the uterus at the time of replacement and the absence of infection thereafter; reproductive monitoring is recommended.
References
Content reviewed by the TunisieVet editorial team · Updated 09 August 2026
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