Uterine prolapse can take place during delivery or in the hours that follow. Cases of spontaneous abortion also carry a small risk for the condition. Most commonly, the uterus will prolapse after the last kitten has passed through the birth canal. While this problem is a severe health issue on its own, it can become far more dangerous if the uterine artery ruptures in the process. This can lead to the cat going into shock from blood loss. Cats have very pronounced uterine horns (the point where the fallopian tubes and the uterus meet). One or both of these horns may pass through the cervix during a prolapse. Cats older than two years have a higher risk of uterine prolapse during birth. Emergency veterinary care is needed in all instances of this disorder.

The uterus is an organ found in female mammals that houses developing fetuses. The uterus has an exit called the cervix, which dilates during delivery. The strong muscles of the uterus then push the fetuses through the vulva opening. Sometimes a portion of the uterus may also pass through the cervix. This occurrence is called a uterine prolapse. It can occur in cats, although reports are rare.

While some cases of uterine prolapse may not be externally visible, most cats suffering from the issue will develop a “doughnut” shaped protrusion in the vaginal area. This protrusion is often very unclean, with fecal matter, hair or after-birth tissue stuck to it. Signs to watch for include:

While few cases may be idiopathic (have an unknown cause), most instances of uterine prolapse take place after a long or strenuous delivery. Improper human intervention can also cause the uterus to pass with the kittens. Known causes include:

If your cat has just delivered kittens and is experiencing any symptoms listed above, take it to a veterinary clinic or animal hospital immediately. Once there, a vet will perform a complete physical examination of the cat. If obvious visual signs are not present, the vet may palpate inside the vulva or use a tool to assist in the assessment. A uterine prolapse must be differentiated from a vaginal prolapse (an issue in which multiple organs may fall out of place due to muscular weakness). 

Full blood work will be needed, including a complete blood count and a biochemical profile to assess the cat's overall health. Urinalysis may also be run at this time. X-rays or ultrasounds may be used to see the extent of the prolapse or to check for any fetuses still inside the cat. A biopsy of the affected tissue may be taken for neoplastic testing (to see whether it is cancerous or not). Vaginal discharge may be collected for culture testing to identify any bacteria that may be causing infection in the cat. 

If severe blood loss has taken place, the cat may be in shock and may need supportive care for stabilization prior to any procedures. In ideal situations, the goal is to return the uterus to its proper position in the body. This is not always possible.

If the protruding uterine tissue is still healthy, it may be possible to gently push it back inside the body. The tissue should be cleansed before this is attempted, and the opening may need lubrication. Some situations may also call for an episiotomy (the surgical enlargement of the vaginal opening). General anesthesia is required to manually replace the uterus.

If the cat's situation is very severe, or if the uterine tissue has begun to die, a complete removal of the uterus may be necessary. This surgery is often referred to as “a spay”. While spay surgeries are quite typical, complications such as uterine infection can make the procedure have higher risks. The cat will no longer be able to breed if an ovariohysterectomy is completed.

In rare instances, a veterinarian may suggest only partially removing the uterus. This procedure may be used if some uterine tissue death has occurred, but there is good reason to continue breeding the cat. It is not always successful. 

A prescription for antibiotics may be administered if a bacterial infection has been found in the cat. Post-surgery, a broad spectrum antibiotic may be given to prevent infections from developing. These prescriptions generally last from one to four weeks.

If your cat has undergone a surgical procedure, follow all instructions given by the veterinarian upon discharge. Monitor the incision site daily to ensure it is clean and that no signs of infection have developed. Prevent the cat from licking herself or biting at the wound during the healing process. An Elizabethan collar may be helpful for this. Administer all medications as prescribed. Ensure that your cat is urinating regularly. If a manual replacement has been performed, watch for any reappearance of uterine tissue.

A full spay is the only way to completely guarantee that the issue will not recur. Prognosis for this surgery is very good. If the cat has made a full recovery from a manual replacement, it is likely that it will be able to breed once again. Uterine prolapse is possible in subsequent pregnancies. If you assist your cat during delivery of kittens, be very careful to not force kittens or tissue out of the birth canal.