Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Postboks 5003 NMBU, Ås, 1432, Norway.
Dyrehelsetjenesten i Ringsaker, Hersethøgda 239, 2355, Gaupen, Norway.
Acta Vet Scand. 2023 Sep 11;65(1):38. doi: 10.1186/s13028-023-00701-1.
Bovine uterine prolapse is a sporadic but life-threatening postpartum condition. The aims of this study were; (i) to determine which clinical findings determined the likelihood of treatment vs. culling, (ii) to identify the treatment methods currently employed by Norwegian veterinary surgeons and evaluate their effect on survival, (iii) to determine if clinical findings at the time of treatment could be used to determine prognosis. Practicing veterinary surgeons in Norway were contacted and asked to fill out a questionnaire on cases of bovine uterine prolapse they attended between February and October 2012. The questionnaires gathered data on signalment, clinical presentation, treatment, and outcome. These data were supplemented with culling data from the Norwegian Dairy and Beef Herd Recording Systems. The chi-squared test and logistic regression modelling was performed to identify likelihood of treatment and cox proportional hazard modelling was performed to identify the hazard of death after treatment.
Data from 126 cases of bovine uterine prolapse were collected (78 beef and 48 dairy cows). Twenty-six cows (21%) were emergency slaughtered, or underwent euthanasia, without treatment. Of the remaining 100 cases amputation of the uterus was performed once and repositioning was performed in 99 cases. Survival data were missing from 2 of the cases that had undergone treatment leaving a study sample of 97 cases (64 beef and 33 dairy cows). Multivariable logistic regression analysis of the explanatory variables showed that beef cows were more likely to be treated than dairy cows (OR = 0.32, 95% CI 0.13 to 0.81, P = 0.017) and that cows with a significantly oedematous or traumatised uterus were less likely to be treated (OR = 0.26, 95% CI 0.10 to 0.67, P = 0.006). Treatment methods amongst Norwegian practitioners were broadly similar. In a multivariable model cows general clinical state at time of treatment was positively correlated with survival (HR = 0.29, 95% CI 0.29 to 0.73, P = 0.008) and a history of a vaginal prolapse prepartum increased the hazard of death (HR = 2.31, 95% CI 1.08 to 4.95, P = 0.031) in the first 30 days after treatment of a uterine prolapse. In the first 180 days after treatment only veterinary assessment of a cows' general clinical state was correlated with hazard of death (HR = 0.432, 95% CI 0.20 to 0.91, P = 0.046).
This study shows that the production system and extent of uterine damage affect the likelihood of treatment, and that practitioners use similar treatment methods. A cows' general clinical state at time of treatment was positively correlated with survival, and a history of a vaginal prolapse prepartum increased the hazard of death in the first 30 days after treatment of a uterine prolapse.
牛的子宫脱垂是一种偶发性但危及生命的产后疾病。本研究的目的是：（i）确定哪些临床发现决定了治疗与淘汰的可能性，（ii）确定目前挪威兽医采用的治疗方法，并评估其对生存率的影响，（iii）确定治疗时的临床发现是否可用于确定预后。联系了挪威的执业兽医，请他们填写一份关于他们在 2012 年 2 月至 10 月期间治疗的牛子宫脱垂病例的问卷。该问卷收集了关于牛的一般情况、临床表现、治疗和结果的数据。这些数据由挪威奶牛和肉牛记录系统的淘汰数据补充。进行了卡方检验和逻辑回归模型分析，以确定治疗的可能性，并进行了 Cox 比例风险模型分析，以确定治疗后死亡的风险。
共收集了 126 例牛子宫脱垂病例（78 例肉牛和 48 例奶牛）的数据。26 头奶牛（21%）未经治疗即被紧急屠宰或实施安乐死。在其余 100 例病例中，有 1 次进行了子宫切除术，99 例进行了复位。有 2 例接受了治疗的病例的生存数据缺失，因此研究样本为 97 例（64 例肉牛和 33 例奶牛）。对解释变量的多变量逻辑回归分析表明，肉牛比奶牛更有可能接受治疗（OR=0.32，95%CI 0.13 至 0.81，P=0.017），且明显水肿或受伤的子宫牛不太可能接受治疗（OR=0.26，95%CI 0.10 至 0.67，P=0.006）。挪威从业者的治疗方法大致相似。在多变量模型中，牛在治疗时的一般临床状态与生存率呈正相关（HR=0.29，95%CI 0.29 至 0.73，P=0.008），且产前阴道脱垂史增加了治疗后 30 天内死亡的风险（HR=2.31，95%CI 1.08 至 4.95，P=0.031）。在治疗子宫脱垂后的前 180 天内，只有兽医对牛的一般临床状态的评估与死亡风险相关（HR=0.432，95%CI 0.20 至 0.91，P=0.046）。
本研究表明，生产系统和子宫损伤程度影响治疗的可能性，且从业者采用相似的治疗方法。牛在治疗时的一般临床状态与生存率呈正相关，且产前阴道脱垂史增加了治疗后 30 天内死亡的风险。
