Uterine Prolapse in Horses: Mare Foaling Emergency and Immediate Care
- See your vet immediately. A uterine prolapse in a mare is a life-threatening foaling emergency because severe bleeding, shock, and tissue damage can happen fast.
- This condition usually happens immediately after foaling or within a few hours after delivery, when the uterus turns inside out and protrudes from the vulva.
- While you wait for your vet, keep the mare quiet, prevent her from walking if possible, protect the exposed tissue with clean damp towels or a clean sheet, and do not try to force the uterus back in yourself.
- Common complications include hemorrhage, contamination, tearing, shock, retained placenta, metritis, and later laminitis, so even mares that look stable still need urgent veterinary care.
- If treated quickly, many mares can recover and may return to breeding, but prognosis depends on how much bleeding, trauma, and contamination occurred before treatment.
What Is Uterine Prolapse in Horses?
See your vet immediately. Uterine prolapse is a rare but critical postpartum emergency in mares. It happens when the uterus turns inside out and comes through the cervix and vulva after the foal is delivered. In horses, this most often occurs immediately after foaling or within the first few hours.
Even though it is uncommon, it is treated as an emergency because the exposed uterus can swell, become contaminated, tear, or lose blood supply. Large uterine blood vessels can also rupture. That means a mare can decline quickly from hemorrhage or shock, even before obvious collapse happens.
For a pet parent, the appearance can be dramatic. You may see a large, dark red to pink mass hanging from the vulva, sometimes with fetal membranes still attached. The mare may seem restless, weak, painful, or surprisingly quiet. Either way, this is not something to watch at home.
Fast veterinary care matters. Early protection of the tissue and prompt replacement by your vet give the mare the best chance of recovery and reduce the risk of infection, uterine damage, and future fertility problems.
Symptoms of Uterine Prolapse in Horses
- Large red, pink, or dark tissue mass protruding from the vulva after foaling
- Retained fetal membranes attached to the prolapsed tissue
- Heavy bleeding or blood dripping from the exposed tissue
- Restlessness, straining, pawing, or repeated attempts to lie down
- Weakness, trembling, pale gums, fast heart rate, or collapse
- Swollen, dirty, or traumatized uterine tissue
Any visible tissue protruding from the vulva after foaling should be treated as an emergency until your vet says otherwise. In mares, uterine prolapse is rare, but when it happens the situation can worsen fast because of swelling, contamination, and bleeding.
Call your vet at once if the mare has a mass hanging from the vulva, seems weak, or is still straining after delivery. If she becomes pale, sweaty, wobbly, or collapses, that raises concern for shock and makes immediate veterinary help even more urgent.
What Causes Uterine Prolapse in Horses?
Uterine prolapse in mares is usually linked to the period right after foaling, when the cervix is still open and the uterus is rapidly changing size. It is considered uncommon in horses, but several factors may increase risk. Reported associations include dystocia, excessive traction during delivery, retained fetal membranes, abortion, and poor uterine tone after birth.
Strong straining after foaling may also contribute, especially if the uterus is heavy, fatigued, or still attached to membranes. In some cases, low calcium, exhaustion, or trauma to the reproductive tract may play a role, although the exact trigger is not always clear in an individual mare.
What matters most for pet parents is that this is not a home-management problem and it is not caused by one single mistake in every case. Sometimes it follows a difficult delivery. Sometimes it appears after what seemed like a normal foaling. Your vet will look at the full picture, including the foaling history, whether the placenta passed normally, and whether there are signs of tearing, hemorrhage, or infection.
Because uterine prolapse can overlap with other postpartum emergencies, your vet may also assess for retained placenta, vaginal or cervical trauma, uterine tears, metritis, and early endotoxemia. Those complications often shape both treatment choices and recovery.
How Is Uterine Prolapse in Horses Diagnosed?
Diagnosis is often based first on what your vet sees: a postpartum mare with uterine tissue protruding from the vulva. Even when the prolapse is obvious, the next step is just as important. Your vet needs to determine how stable the mare is and whether there are complications such as hemorrhage, shock, tearing, contamination, or retained placenta.
A focused emergency exam usually includes heart rate, gum color, hydration, pain level, and the amount of bleeding. Your vet will inspect the prolapsed tissue for swelling, trauma, and viability before attempting replacement. In some mares, sedation, epidural anesthesia, or both are used to reduce straining and make handling safer.
After the uterus is cleaned and replaced, your vet may perform a careful internal exam and sometimes ultrasound to confirm the uterus is fully returned to normal position and to look for retained membranes, fluid, or damage. Bloodwork may be recommended if there is concern for blood loss, infection, inflammation, or metabolic problems.
This is one reason fast care matters so much. The diagnosis is not only "yes or no" for prolapse. Your vet is also diagnosing how severe the emergency is, what secondary problems are present, and what level of monitoring the mare needs over the next 24 to 72 hours.
Treatment Options for Uterine Prolapse in Horses
Spectrum of Care means you have options. Here are treatment tiers at different price points.
Budget-Conscious Care
- Emergency farm call and physical exam
- Sedation and/or epidural to reduce straining
- Protection and gentle cleaning of exposed uterine tissue
- Manual replacement of the uterus on the farm if tissue is viable and the mare is stable
- Basic medications such as oxytocin after replacement, anti-inflammatory medication, and antibiotics when indicated
- Short-term monitoring instructions for hemorrhage, colic signs, fever, discharge, and laminitis risk
Recommended Standard Treatment
- Emergency exam plus on-farm or hospital stabilization
- Sedation, epidural, IV catheter placement, and fluid therapy as needed
- Thorough cleaning, reduction of swelling, and careful uterine replacement
- Post-replacement uterine support with oxytocin and monitoring for re-prolapse
- Bloodwork and reproductive tract assessment for tears, retained membranes, or infection
- Hospitalization or extended observation for pain control, antibiotics when indicated, anti-inflammatory medication, and laminitis surveillance
Advanced / Critical Care
- Referral hospital or intensive equine hospital care
- Aggressive IV fluids, repeated bloodwork, and continuous monitoring
- Management of severe hemorrhage, shock, endotoxemia, or uterine trauma
- Ultrasound and advanced reproductive evaluation
- Blood transfusion if needed
- Surgical treatment if there is irreparable tearing, devitalized tissue, or complications that cannot be managed medically
Cost estimates as of 2026-03. Actual costs vary by location, clinic, and individual case.
Questions to Ask Your Vet About Uterine Prolapse in Horses
Bring these questions to your vet appointment to get the most out of your visit.
- Is my mare stable right now, or does she need referral hospital care?
- Do you think the uterus is healthy enough to replace on the farm, or is surgery a concern?
- Is there evidence of tearing, heavy blood loss, retained placenta, or infection?
- What medications are you recommending after replacement, and what is each one for?
- What warning signs should I watch for over the next 24 to 72 hours, including laminitis, fever, discharge, or colic signs?
- What activity restriction and stall management do you want for her recovery?
- How might this affect future fertility or breeding plans?
- What is the expected cost range for the care you recommend today, and what would make that range increase?
How to Prevent Uterine Prolapse in Horses
Not every case can be prevented, but good foaling management may lower risk. The biggest practical step is close observation around delivery so problems are recognized early. Difficult labor, prolonged straining, retained fetal membranes, and abnormal postpartum behavior all deserve prompt veterinary attention.
Work with your vet before the due date if your mare has a history of dystocia, retained placenta, abortion, or other reproductive problems. A foaling plan can include when to call, what supplies to keep ready, and whether the mare should foal at home or in a setting with faster access to emergency care.
During foaling, avoid forceful traction unless your vet has instructed you exactly what to do. Excessive pulling can increase trauma to the mare's reproductive tract. After foaling, monitor whether the placenta passes normally, whether the mare continues to strain, and whether any tissue appears at the vulva.
Good postpartum care also matters. Keep the foaling area clean, have your vet examine mares promptly after difficult deliveries, and do not delay care for retained placenta or signs of illness. Early treatment of postpartum complications may reduce the chance that one emergency turns into several.