Uterine Prolapse in Cows & Buffaloes: What to Do

A uterine prolapse — where the whole uterus turns inside out and hangs behind the cow after calving — is a genuine veterinary emergency. Call a veterinarian immediately; an untreated cow can die of haemorrhage or shock within hours. While you wait, keep her calm and restrained so she cannot move about, and protect the exposed tissue with a clean, damp sheet. Do not attempt to push it back yourself.

This is different from a vaginal prolapse, which usually appears before calving as a pink mass that may go back in when the animal stands. Both need veterinary attention, but uterine prolapse is the more immediately life-threatening of the two.

How to recognise it

Uterine prolapse almost always occurs within a few hours of calving, while the cervix is still open. What you see is a large, heavy, red-to-purple mass hanging behind the animal, often reaching the hocks, with the characteristic button-like caruncles (the maternal side of the placenta) visible on its surface. The cow is usually still straining, and may be down.

The key distinctions:

• Uterine prolapse: after calving, very large, caruncles visible, does not go back on its own. Emergency.
• Vaginal prolapse: usually before calving, smaller and smoother, often reduces when the animal stands. Serious but less immediately critical.
• Retained placenta: membranes hanging, but no large organ mass. See our article on retained placenta in cows and buffaloes.

What to do in the first minutes

1. Call your veterinarian now. Say clearly that the uterus is out. This is the single most important step; nothing else you do substitutes for it.
2. Restrain and calm the animal. A cow that walks or runs with a prolapsed uterus can tear blood vessels and bleed to death. Move other animals away.
3. Position her if she is down. If safe, ease her onto her chest with both hind legs extended behind her (frog position). This reduces straining and takes pressure off the pelvis.
4. Support and protect the tissue. Lift the mass on a clean, damp sheet or towel roughly level with the vulva so it is not dragging. Keep it moist and clean. Gently pick off loose straw, dung and debris.
5. Keep her cool and shaded in hot weather; keep the tissue from drying out.
6. Do not attempt to replace it, do not apply salt or sugar without veterinary instruction, do not let her walk, and do not milk her out until the vet has seen her.

Veterinary guidance is consistent that this is an emergency requiring prompt attention — see, for example, Bovine uterine prolapses – causes, correction and care (Vet Times) and the Alabama Cooperative Extension System guidance on calving complications.

What the veterinarian will do

Treatment involves epidural anaesthesia to stop straining, thorough cleaning of the uterus, careful reduction of any oedema, and replacement of the organ — which is physically demanding and must be complete, with both horns fully everted back into position. The vulva may be retained with sutures for a short period. Most vets will also give calcium, oxytocin and antibiotic cover, and will check for tears.

Do not be tempted to have an untrained person attempt this. Incomplete replacement leaves a horn inverted, which causes ongoing straining, infection and often a second prolapse.

After replacement: the next three weeks

A cow that survives replacement will commonly develop uterine infection and will be slower to breed back. The recovery period matters:

• Watch for infection. Foul-smelling discharge, fever, drop in feed intake or milk yield all need veterinary review.
• Support uterine involution. The uterus needs to contract down and clear itself. Cattle Remedies uterine tonics are used for this phase — Uterotone 3-in-1, Uterotone DS and Uterotone Liquid support uterine cleansing and involution after calving. They complement, and never replace, the veterinary treatment plan. Our guide to cattle uterine tonics in India explains the differences.
• Correct calcium and minerals. Low blood calcium reduces uterine muscle tone and is strongly associated with prolapse and retained placenta. Cattle Remedies Chelated Calcicril supplies bioavailable calcium; Verymin covers the broader chelated mineral and vitamin requirement.
• Protect appetite and energy. A cow recovering from prolapse eats poorly at exactly the moment her energy demand peaks. Cattle Remedies Heprich supports liver function and metabolism, and Grazup supports appetite and feed intake during recovery.
• Delay rebreeding. Give the uterus a full recovery before service; discuss timing with your veterinarian.

Why it happens — and what you can actually control

Low blood calcium (hypocalcaemia)

The most important controllable factor. Calcium drives uterine muscle contraction; a hypocalcaemic cow has a flaccid uterus and poor abdominal tone. Prevention starts in the dry period — keep calcium low before calving so the cow's own mobilising mechanism stays active, then supply calcium at and after calving. See our articles on milk fever and dry period management.

Prolonged or assisted calving

Difficult calvings and excessive traction during assistance both raise the risk. Pull only when necessary, in time with the cow's own straining, and downward once the head and shoulders are through.

Retained placenta and continued straining

Anything that keeps a cow straining after calving increases risk. Retained membranes are a common trigger.

Poor body condition and mineral status

Both very thin and over-conditioned cows are at higher risk. Chronic mineral deficiency — calcium, phosphorus, magnesium, selenium — weakens uterine and pelvic muscle tone. Our article on mineral deficiency in cattle covers the warning signs.

Getting her up quickly after calving

Encouraging a cow to stand and move soon after calving helps the uterus drop back into the abdomen and the horns straighten, which reduces prolapse risk.

Prevention checklist

• Manage the dry period properly: 60 days, controlled energy, low calcium until calving.
• Maintain year-round chelated mineral and vitamin supplementation.
• Provide calcium support at calving, particularly for older and high-yielding animals.
• Keep the calving area clean, dry and level — a sloping floor with the hindquarters lower increases risk.
• Assist calvings correctly and only when needed.
• Get the cow up and moving as soon as she is able after calving.
• Manage retained placenta promptly rather than waiting.
• Support uterine involution in the first two weeks after calving.

Frequently asked questions

Can a cow survive a uterine prolapse?

Yes, if it is treated promptly and correctly. Survival depends largely on how quickly the uterus is replaced and how much haemorrhage, contamination and tissue damage occurred first. Delay is the main determinant of a poor outcome, which is why the veterinarian should be called the moment it is seen.

Will she prolapse again at her next calving?

Uterine prolapse is not generally considered heritable and does not usually recur at subsequent calvings, though the underlying cause — hypocalcaemia, difficult calving, poor mineral status — will recur if it is not corrected. Vaginal prolapse before calving is different: it does tend to recur, and such animals are often culled.

Can I put the uterus back myself if no vet is available?

You should not. Replacement requires epidural anaesthesia to stop straining and complete eversion of both horns; an incomplete or forceful attempt causes tearing, severe haemorrhage and re-prolapse. If you are genuinely remote from veterinary help, telephone a veterinarian for guidance while you keep the animal restrained and the tissue clean, moist and supported, and arrange transport of a vet to the farm as the priority.

The bottom line

Uterine prolapse is dramatic, but the response is simple: call the vet, keep her still, keep the tissue clean, moist and supported, and do not attempt replacement yourself. Prevention is mostly about calcium and mineral status through the dry period and around calving, calving assistance done properly, and getting the cow up and moving afterwards.

This article is for general educational purposes and is not a substitute for veterinary care. Uterine prolapse is a medical emergency — contact a qualified veterinarian immediately.

By Cattle Remedies