Cat Uterine Prolapse: Wet Gauze, Never Push Back

A uterus that comes out after birth is a 30-minute problem: the tissue is viable while it is pink and wet, and it starts to dry, swell and crack within 15 to 20 minutes of open air. Two rules decide the outcome. Cover it with saline-soaked gauze and keep it wet all the way to the clinic. Never push it back in.

Prolapse happens in the first 24 to 48 hours after delivery, most often within 6 hours, and it can follow a difficult birth, a single large kitten, or hard straining after the last one. The mass hangs from the vulva, 3 to 8 cm long. A cat in this state is also at risk of shock and of bleeding, so the drive matters as much as the dressing.

What you are looking at, in 60 seconds

Three checks separate a prolapse from a normal placenta or a vaginal fold. Position: tissue that hangs outside the vulva and does not retract when the cat relaxes. Surface: velvet-like pink lining, with a hollow tube or a split opening at the end. Color: pink is viable, dark red means venous congestion, purple-black means necrosis already started. Take one photo in daylight, then stop handling it.

Feel the abdomen once, gently, for 2 reasons: a kitten still inside means the birth is not finished, and a hard uterus means the organ may be torn. Count the placentas you have seen; a retained placenta beyond 12 to 24 hours raises the infection risk sharply. Check the gums: white or gray with refill over 2 seconds points to blood loss, and a heart rate over 200 with panting means shock is close.

Wet gauze in the first 30 seconds

Use sterile saline if you have it, otherwise cooled boiled water. Soak 4 layers of gauze, or a clean cotton pad, until it is wet through but not dripping, and lay it over the whole mass without wiping. Do not rinse, scrub or dab: the lining is 1 to 2 mm thick and every wipe takes surface cells with it. Re-wet every 5 minutes on the way, or when the edges feel dry.

Position matters as much as moisture. Fold 2 towels into a roll 10 to 15 cm high under the hindquarters so the rear sits higher than the front, which reduces swelling. Put an Elizabethan collar on, because a cat will lick it within minutes, and licking turns a repairable organ into a torn one. Keep the room at 24 to 26 C; a wet, exposed organ loses heat fast.

Never push it back: 4 reasons

First, the wall is thin: a finger pushing on 1 to 2 mm of stretched tissue tears it, and a tear inside the abdomen means peritonitis within 24 to 48 hours. Second, direction is blind: without seeing the cervix, a push can fold the uterus back on itself and kink the blood supply. Third, the organ may already be dirty, and pushing contamination upward seeds the abdomen. Fourth, a kitten may still be inside, and pushing the uterus back over a kitten kills both.

Do not pull it either, do not cut anything that looks like a cord, and do not apply iodine, alcohol or hydrogen peroxide: all 3 damage the mucosa on contact and turn pink tissue white within 1 to 2 minutes. Vets wash with warm saline for a reason, and that wash belongs at the clinic.

On the way: 5 things you must not do

Use a rigid box with a towel, keep the cat on her side, and leave the gauze in place. Then hold 5 rules: no pushing back; no pulling or tying off; no antiseptics or ointments; no food or water, since anesthesia may follow within 2 hours; and no waiting to see if it goes back by itself, which it will not. Call the clinic while someone else finds a box, and say 3 things: prolapse after birth, how long ago she delivered, and how far you are.

Keep the car at 24 to 26 C and drive 30 to 40 km per hour on broken roads. Ask for a clinic with a surgeon on site, because this needs general anesthesia and an operating room within the hour.

0 to 24 hours: the clock on the tissue

Time	Tissue state and temperature	What you do	What the clinic does
0 min	Pink, wet, 3 to 8 cm	Saline gauze, collar, hindquarters up 10 to 15 cm	Nothing yet
30 min	Still pink, not dry	Leave for the clinic, re-wet every 5 min	Examines, starts IV fluids
2 h	Swelling sets in after 60 to 90 min	Wait in reception, no food	Anesthesia, warm saline wash 2 to 3 L, replace
6 h	Body temp 37.5 to 38.5 C	Ask about the kittens and about pain relief	Monitors urine output, antibiotics, oxytocin if the vet chooses
24 h	Temp under 39.2 C	Small meals, watch the incision	Recheck swelling, discharge, appetite

Purple-black tissue at any point means the window has closed: that part will not come back, and surgery becomes removal rather than replacement. A cat that arrives with 30 percent of the organ black keeps the rest, not that part.

At the clinic: wash, replace, or remove

Replacement is the first option, done under general anesthesia with the cat's rear end raised. The vet washes with 2 to 3 liters of warm saline, checks for tears, and pushes the organ back with the cervix leading, then places a loose stitch to hold it for 24 to 48 hours. Oxytocin and antibiotics are prescription decisions made case by case, not at home.

Removal is chosen when the tissue is necrotic or torn, and most vets spay at the same surgery, since a cat that has prolapsed once tends to repeat it. Budget 400 to 1,200 dollars for replacement with fluids, 800 to 2,000 for removal with a 1 to 2 night stay, and add 300 to 800 if blood loss needs a transfusion.

5 steps, in order

1. Photograph the mass in daylight, then cover it with saline-soaked gauze; do not wipe.
2. Roll 2 towels under the hindquarters, 10 to 15 cm, and fit a collar.
3. Call a clinic with a surgeon, and say prolapse, birth time and drive time.
4. Drive at 24 to 26 C cabin temperature, 30 to 40 km per hour, re-wetting gauze every 5 minutes.
5. Hand over the placenta count and the number of kittens; refuse food, water and every home remedy.

Bleeding and shock follow the same first-aid logic as any birth emergency, and the handling rules for a prolapsed rectum look almost identical, so the positioning advice in rectal prolapse transfers directly. If the eye is also injured during straining, see eye prolapse and glass injury. Never apply a home antiseptic to exposed tissue; the safe list is in the toxic plant and product checker.

Terms mentioned in this article

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