SlideShare una empresa de Scribd logo
1 de 184
GARBHA VYAPAD
Dr Jasmine Gujarathi
Prof & Head
Dept of Prasuti tantra and Stri roga
G J Patel Institute of Ayurveda Studies and Research
New Vallabh Vidyanagar
Anand, Gujarat
Garbha vyapad
 Upavishtaka
 Nagodara
 Makkal
 Mudhagarbha
 Gudhagarbha
 Vishkambha
 Jarayu
 Garbha pata
 Abortion
 IUGR
 IUD
 Obstructed labour
Garbha strava - pata
Nidana – etiological factors


 25/
40

4/18
Nidana..cont’d



Garbha vyapad


 Psychological stress, fear, strain with physical or any external trauma can
cause death
 This description is given in Mritagarbha
1. Abnormalities in the factors responsible for proper
growth and development of fetus – can cause IUD or
preterm labour
2.After fourth month of pregnancy –
Anger, grief, jealousy, fear, excessive coitus, exercise,
irritation, supression of natural urges, sitting – standing
and sleeping on uneven place, abnormal postures,
suppression of thirst and hunger, use of stale food and
bleeding per vagina.
3. According to sushrut, etiology of mudhagarbha and
garbhastrava pata are same
Coitus, travelling, riding on horse, falling from height,
trauma, suppresssion of natural urges, hot or
pungent diet, grief, diarrhoea, excessive use of kshara,
emetics and purgatives, indigestion and use of
abortificient drugs.
Krimi, vata and aghata – example of fruit
As it gets detached in the similar way fetus gets detached
due to above factors.
4. Vagbhatta – Due to excessive
accumulation of doshas, non avoidance
of contraindicated articles, due to
diseases or deeds of previous life of
either mother or fetus
Samanya Lakshana – Clinical features
ABORTION
Definition:
 Termination of pregnancy before 20-22-24 weeks of
gestation
 Or if the fetus weight < 500g
 If > 24 w & > 500 g ➔ ~ premature labour
 Abortus
 Abortion occurring without medical or
mechanical means to empty the uterus is
referred to as spontaneous
 Another widely used term is miscarriage
Classification
Etiology
 Fetal factors
 Maternal factors
 Paternal
 Unknown
 Trauma
Fetal factors / Genetic factors
 1. Chromosomal abnormality
Autosomal trisomy (Down’s syndrome), Trisomy 16
Polyploidy
Monosomy
2. Gross congenital abnormalitites
3. Blighted ovum
4. Knots in umbillical cord
5. Twin pregnancy
Maternal factors
1. Maternal illness –
a) Hypoxia – Chronic respiratory disease, anaemia, heart
failure
b) Chronic illness – hypertension, chronic nephritis, chronic
wasting diseases
Endocrine factors
Hypothyroidism,
Hyperthyroidism,
Diabetes mellitus,
Inadequate corpus luteum.
Cervico – uterine factors
(a) Cervical incompetence
(b) Congenital malformation of uterus
(c) Uterine tumor – fibroid
(d) Retroverted uterus
(e) Asherman’s syndrome
(a) Infection – TORCH
Toxoplasmosis
Rubella
Cytomegallo virus
Herpes simplex
Malaria, protozoal infection,
Immunological factors –
Antiphospholipid antibody syndrome
Lupus Anticoagulant
Human Leucocyte Antien
Blood group incompatibility – Rh Incompatibility, ABO
incompatibility
Environmental factors
Smoking
Alcohol
IUCD
Anaesthetic gases
Lead
Radiation
Trauma
 Direct injury
 Journey
 P/v Examination in susceptible invididuals
 Psychic shock
Iatrogenic
 Amniocentesis
 Cordocentesis
 CVS
 Radiation
 Quinine
 Warfarin
 Ergot derivatives
 Prostaglandins
 Cytotoxic drugs
Deficiency
 Folic acid
 Vitamin A
 Vitamin E
Paternal factors
Defective sperm
Garbha vyapad
Pathology
Hemorrhage into the decidua basalis, followed by
necrosis of tissues adjacent to the bleeding
If early, the ovum detaches, stimulating uterine
contractions that result in its ovulation
Gestational sac is opened , fluid surrounding a small
macerated fetus or alternatively no fetus is visible
→ blighted ovum
Categories of spontaneous abortion
 Threatened abortion
 Inevitable abortion
 Complete abortion
 Incomplete abortion
 Missed abortion
 Recurrent abortion
Garbha vyapad
Threatened abortion
 Definition
 The process of abortion has started but has not progressed to state from which
the recovery is impossible.
 Bleeding is frequently slight, but may persist for days or weeks
 Frequency
 Extremely common (one out of four or five pregnant women)
 Symptoms
 Usually bleeding begins first, brisk, brownish or bright red in colour
 Dull abdominal pain follows a few hours to several days later, backache
 Presence of bleeding & pain
→ Poor prognosis for pregnancy continuation
Categories of spontaneous abortion
Threatened abortion
 Examination
 P/s – Bleeding through external os, bright red
 P/v – closed os
Uterus – soft, size corresponds to period of amenorrhoea
 Investigations
USG / TVS
Blood grouping
Serum progesterone - > 25 ng/ml
Treatment
 Bed rest
 Progesterone (IM)
 Rh-negative women with threatened abortion
should receive anti-D immunoglobulin
Categories of spontaneous abortion
Threatened abortion
 Treatment :
 Vaginal sonography
 Serial serum quantitative hCG
 Serum progesterone
→ can help ascertain if the fetus is alive & its location
 Gestational sac(+) & hCG < 1000mIU/ml
→ gestation is not likely to survive
→ If any doubt(+), check the serum hCG level at intervals of
48hrs
→ if not increase more than 65%, almost always hopeless
 Serum progesterone value < 5 ng/ml
→ dead conceptus
Categories of spontaneous abortion
Adjuvants
 Tocolytics
 Folic acid
 Aspirin
Inevitable abortion
 Definition : The changes of abortion have
progressed to a state from which the continuation
of pregnancy is impossible.
 Clinical features : Threatened abortion +
Increased vaginal bleeding
Aggravation of pain - colicky
General condition detoriates with increased
bleeding
 P/v Examination - Internal examination reveals
dilated os through which the product of conceptus
are felt
Categories of spontaneous abortion
Invevitable abortion
 Management –
Improve general condition
Accelerate process of expulsion
Maintain asepsis
Before 12 weeks – D&C
After 12 weeks – Oxytocin – accelerate uterine
Contraction (10 units in 500 ml RL or NS 40-60 drops
per minute)
Garbha vyapad
Follow up
 Iron supplementation
 Contraceptive
 Investigations
Complete abortion
 Following complete detachment & expulsion of the
conceptus
Clinical features
Subsidence of abdominal pain
No bleeding
P/v examination –
 Uterus firm, smaller than period of amenorrhoea
 The internal cervical os closes
USG – empty uterus
Treatment : Hematinics, Anti D, Antibiotics
Categories of spontaneous abortion
Incomplete abortion
 Expulsion of some but not all of the products of conception
during 1st half of pregnancy
 The internal cervical os remains open & allows passage of
blood
 Clinical features
1. Continuation of pain and bleeding
 Examination
P/s – Uterus is smaller than period of amenorrhoea
Cervix dilated
The mass expelled is incomplete
Management
 Resuscitation IV fluids
 Evacuation under analgesia or anesthesia D&E
 Tab Misoprost 200
 Hematinics
 Anti D
 Antibiotics
Missed abortion
 Retention of dead fetus inside the uterus for variable
period.
 Pathology – Macerated or mummified, liquor absorbs –
after 12 weeks
 Before 12 weeks – Carneous mole / Fleshy mole
 Repeated haemorrhages in choriodecidual space disrupt
the villi from attachments.
 Clotted blood is collected called as mole.
Categories of spontaneous abortion
Missed abortion
 Clinical features
 Persistence of brownish vaginal discharge
 Subsidence of pregnancy symptoms
 Retrogression of breast changes
 Cessation of uterine growth
 Examination –
 P/s Cervix feels firm, uterus firm smaller then Amenorrhoea
 No FHS on doppler
Management
 < 12 weeks
 Medical management – Misoprost 800 Microgram vaginally
– repeat after 24 hours
 Suction evacuation
 > 12 weeks
 Prostaglandin
 Oxytocin – 10- 20 units in 500 ml RL or NS 30 drops / min
 Picture of laminaria
Laminaria tent
Garbha vyapad
Septic Abortion
Definition – Any abortion associated with clinical evidences of
infection of the uterus and its contents is called septic abortion.
Clinical criteria of septic abortion
1. Rise in temperature - 100.4 F
2. Offensive and purulent vaginal discharge
3. Lower abdominal pain and tenderness
4. Malaise
Causes
 Endogenous cause – Infection elsewhere,
decreased immunity
 Anaerobic, Aerobic
 Exogenous or mixed – from outside – Antiseptic
and aseptic precautions not taken, incomplete
evacuation
Clinical features
 Temperature with chills and rigors
 Tachycardia
 Abdominal or chest pain
 Diarrhoea, vomiting
 P/s and P/v – Tenderness +++, purulent discharge
Clinical grading
 Grade I – Localized in uterus
 Grade II – Adnexal structures – parametrium, ovaries,
tubes, pelvic peritoneum
 Grade III – Generalized peritonitis, endotoxic shock,
jaundice, renal failure
Investigations
 Cervical or vaginal swabs for culture
 Blood tests with coagulation profile
 Urine analysis
 USG
Prevention and Management
 Prevention
 Contraceptive use
 Legalized abortion
 Aseptic precautions during induction and management
Management of septic abortion
 Hospitalization
 Grade I
 Antibiotics
 Prophylactic antigas gangrene serum and antitetanus serum
 Analgesics and sedatives
 Evacuation 24 hours after antibiotics
 Grade II
 Antibiotics & supportive treatment
 Colpotomy wit suction evacuation
 Grade III
 Antibiotics
 ICU
 Laparotomy / Hysterectomy
Recurrent Abortion
Definition
 Three or more consecutive pregnancy losses
 Affects 1% of fertile couples
Garbha vyapad
Garbha vyapad
INDUCED ABORTION
Definitions . . .
 Induced Abortion: intentional medical or surgical termination
of a pregnancy
 Elective: if performed for a woman’s desires
 Therapeutic: if performed for reasons of maintaining
health of the mother
 In India the abortion was legalized by
Medical Termination of Pregnancy Act – 1971., enforced in
April 1972 revised in 1975…….
MEDICAL TERMINATION OF PREGNANCY REGULATIONS, 2003
Done by registered medical practitioner
Indications
1.Continuation of pregnancy would involve
serious risk of life or grave injury to the
physical and mental health of pregnant
woman.
2. Risk of child being born with serious
physical and mental abnormalities
3. When the pregnancy is caused by rape,
both in cases of minor or major girl and in
mentally imbalanced woman.
4. Failure of contraceptive
First Trimester Abortion
 Early Uterine Evacuation (EUE), Minisuction, Menstrual
Regulation
 Suction Abortion, Vacuum Curettage
 Medical Abortion
Minisuction / Menstrual Extraction
 Introduced in 1972 by Karman and Potts
Minisuction
 Requires early recognition of
pregnancy.
Performs abortions up to 7-8
weeks from LMP
 Cervical dilation not required, 6
mm diameter cannula used
 Simplest, safest, least expensive
 examine aspirated tissue is
essential
https://www.innovating-education.org/2019/04/uterine-aspiration-procedure/
https://www.youtube.com/watch?v=2DLtEhq8wPw
Garbha vyapad
Medical Abortion
 Mifepristone (RU486)
 analogue of progestin
 strong affinity for the progesterone receptor
acting as an antagonist
 a single oral dose given to women 5 weeks or less produces
abortion in 85% of cases
Mifepristone protocol
 Women less than 49 days LMP with confirmed b-hCG
 600mg mifepristone on day 1
 On day three, return for prostaglandin, Misoprost 400 mcg
orally
 Patient remain in clinic four hours, during which time
expulsion of
pregnancy usually occurs
Alternative Regimens
 200 mg Mifepristone
 800 mcg Mistoprostil vaginally
MEDICAL ABORTIONS
 The advantages
 The procedure is non-invasive; no surgical instruments
are used.
 Anesthesia is not required.
 Drugs are administered either orally or by injection.
 The procedure resembles a natural miscarriage
 Disadvantages
 The effectiveness decreases after the seventh week.
 The procedure may require multiple visits to the doctor.
 Bleeding after the abortion lasts longer
than after a surgical abortion.
 The woman may see the contents of her womb as it is expelled
Side effects
 Excessive bleeding
 Nausea
 Vomiting
 Headache
 Diarrhoea
 Backache
 Abdominal pain
 Anxiety
 Loss of appetite
 Incomplete abortion
Dilatation and curettage (D&C)
 Removal of
pregnancy contents by
some mechanical
means
 Vacuum most commonly
used
 12-13 weeks is the
upper limit of
gestational age
D&C (vacuum curettage)
 The cervix must be dilated
to permit larger diameter
suction curettes
 Premedication with
NSAID
 Local (paracervical block),
spinal, conscious sedation,
or general anesthesia
Garbha vyapad
Garbha vyapad
Garbha vyapad
Garbha vyapad
Garbha vyapad
Garbha vyapad
Garbha vyapad
D&E
D&C
 https://www.youtube.com/watch?v=Cux4rVn3dqI
 https://www.youtube.com/watch?v=idk9_BNfiZU
Garbha vyapad
Intrauterine injection of
abortificient
 Prostaglandin, hypertonic saline, hypertonic urea are introduced by
amniocentesis
 Fetus and placenta are aborted vaginally
 Osmotic dilators are used to decrease time to delivery and decrease
complications
 Picture of laminaria
Laminaria tent
Garbha vyapad
Hysterotomy
 Surgical method to remove pregnancy abdominally
(mini-cesarean section)
 Other methods are preferred
Complications - immediate
 Complications of local anesthetic
 Cervical shock
 Cervical lacerations
 Uterine perforation
 Hemorrhage
Complications - delayed
 Bleeding
 retained products
 Infection
 Continued pregnancy
 ectopic
 intrauterine
Samanya Lakshana – Clinical features
 Pain in uterus, sacral, groin region and over the
urinary bladder along with bleeding (Su.sa.10)
This pain is due to vitiation of vayu and bleeding
Is due to expulsion of ‘ama garbha’ and opening of
orifices of ‘artava vaha srotas’


………………….
 Shotha
 Apatanaka
 Arsha
 Vedana
 Pain with or without bleeding
 Excessive bleeding
 Retention of urine
 Burning sensation etc.
Treatment
 Before 3 months – Ajatsara / Ama garbha /
Virrudhaupakrama
(if bleeding starts due to faulty dietary habits of
mother, it will be difficult to cure)
 After 4th month – Garbha sthapana chikitsa
 Treatment of abortion of ama-garbha
Before expulsion
1. Ruksha and shita treatment
2. After observing fast, decoction made from
duralabha, amrita, ushira, parpataka
chandana, ativisha, bala, dhanyaka
3. Trina dhanya and Sali or shastika rice in the form
of peya or solid diet.
4. Yusha prepared from mudga etc for digestion of ama
After digestion of ama – Snigdha, shita karma
After expulsion
1. Madhya pana –
for complete evacuation of uterus and relief of pain
2. Langhupanchamula siddha ruksha peya (without Sneha)
3. Amadhyapa – Yavagu made from Tila and uddalaka, with
Pachaka dravyas, salt and fat free.
4. Peya made from Brihata panchamula with panchakola kalka
(2 months = 2 days)
 In case of incomplete expulsion of ama garbha
Tikshna dravyas are used till complete Expulsion
➢ For treatment of abdominal pain after garbha pata – use
of Arishta
 After complete expulsion of ama garbha
1 Snehapana
2. Basti
3. Diet consisting of appetizing, digestive,
jivaniya, sweet and vatahara dravyas
Treatment of threatened abortion
 External medications
1. Yoni pichu – Ghee + Yashtimadhu, Kshir
2. Lepa – shatdhauta ghrita / sahastra dhaut below umbillicus
3. Parisechan – Below umbillicus by
Decoction of Yashtimadhu or nagrodhadhi gana or cow’s milk
4. Avagahan – cold water
5. Nyagrodhadhi gana – siddha taila pichu
6. Root of kantaki – tie around waist
7. Abhyanga by lakshadi oil
 Internal medications
1. Garbhasthapana gana
2. Pumsavana karma
3. Nyagrodhadi gana – Shunga + Kshir sarpi
4. Jeevaniya gana sadhita kshir or shasti shali
5.
Monthwise treatment of
abortion
First month
Madhuka, Shakabija, Payasya, Surdaru
Second month
Ashmantak, Krishna tila, Tamravalli,(Manjistha) Shatavari
Third month
Vrikshadani, payasya, Priyangu, Utpal, Sariva
Fourth month
Ananta, Sariva, Rasna. Padma, Madhuka
Fifth month
Brihati dwaya, Kashmari, Kshirishunga
Sixth month
Prishnaparni, Bala, Shigru, Gokshura, Madhuparnika
Seventh month
Shringatak, Draksha, Kasheru, Madjuka, Sugar
Eighth month
Kapitha, Bilva, Brihati, Patol, Ikshu, Nidigdhika
Ninth month
Ananta, Sariva, Payasya, Yashtimadhu
Tenth month
Sunthi and payasya
 Varanabandh –
 Kashyap samhita - Revati kalpadhyaya
Garbha vyapad
Garbha Shosha / Vatabhipanna garbha
 Dalhan
Garbha Nadi – Alpa rasa vahan and Akala bhojana – Chirena
Apyayate
Treatment
1. Ruksha to be avoided
2. Brimhaniya drugs, milk and meat soup
3. Milk treated with Madhuyashti, sariva, Kashmari
4. Meat soup of carnivorous animals with brimhaniya drugs
5. Use of milk
IUGR
 Intra uterine growth retardation
 Intra uterine growth restriction
◼ Foetal growth restriction
◼ Small for gestational age (SGA)
◼ 'wasted' and 'stunted'
Intra Uterine Growth Retardation
◼ Intra Uterine Growth Restriction
Definition
 Birth weight less than 10th percentile of those
born at same GA
◼ Low birth weight (LBW) means a baby
with a birth weight of less than 2500Gms,
which could be due to IUGR or Prematurity
Garbha vyapad
Garbha vyapad
 < 1 Kg ELBW
 < 1.5 Kg VLBW
 < 2.5 Kg LBW
 < 10th Percentile – SGA
 10th to 90th Percentile – AGA
 > 90th Percentile – LGA
Normal Fetal Growth
 1st phase – 4th week to 20th week
Hyperplasia – 5gms / day
 2nd Phase – 20 to 28th week
Hyperplasia and Hypertrophy – 15-20gms / day
 3rd Phase – 28 to 40th week
Hypertrophy + accumulation of fat
32 to 34 weeks – 30-35 gm / day
Fetal growth has been
divided into three phases. 1-cellular hyperplasia
 2- hyperplasy &
hypertrophy
 3- hypertrophy
 cell size
 fat deposition
 fetal weight as much as
200 G.r. per week.
Classification/ Types of IUGR
•Small and healthy
•PI Normal, No riskSGA
•Symmetrical
•Assymetrical
True/
Pathological
IUGR
 Pondrel index : Widely used measurement of infants
relative thickness or fatness in relation with height or
length.
 PI = Est Ft Wt / FL3
 8.3 normal
 Rohrer’s Pondrel Index = BW X 100/ Height3
Symmetrical (Type I) 20-30% Asymmetrical (Type II) 70-80%
Early exposure Late exposure (> 28 weeks)
TORCH, Chromosomal abnormalities,
Chemical exposure
Placental insufficiency – PIH,
abruption, pre eclampsia
Decrease in number of cell Cell size decreases
Uniformly small fetus
Ratio normal
HC > AC
PI – normal PI – abnormal
Poor prognosis Good prognosis
Type III
Symmetrical + Asymmetrical
 Initially symmetrical and later assymetrical
 Associated with Hypertension and vascular disease
 Worst prognosis
Other Classification
Early Onset – before 32 weeks
Late Onset – after 32 weeks
 Intrinsic
 Extrinsic
 Combined
 Idiopathic
Classification
Symmetrical Asymmetrical
baby's brain is abnormally
large when compared to the
liver.
may occur when the foetus
experiences a problem
during later development
the baby's head and body
are proportionately small.
may occur when the
foetus experiences a
problem during early
development.
In a normal infant, the brain weighs about three times more than the liver. In
asymmetrical IUGR, the brain can weigh five or six times more than the liver.
Normal growth
 Availability of nutrients – Maternal nourishment
 Transfer of nutrients – Placenta and cord
 Utilization of nutrients – Fetal
Etiology
Availability
 Maternal factors – Malnourishment – glucose, amino acids
 Malabsorption syndrome
 Constitutionally small
 Maternal vascular disease
 Cynotoic heart disease
 Renal disease
 Anaemia
 Smoking, tobacco
 Decreased oxygen
Etiology
Transfer
 Placenta and cord abnormalities
 Abruptions, infarcts, small placenta, other placental
abnormalities
 PIH, Pre eclampsia, DM
 Placenta praevia
 Cord – knots, compression, etc
Etiology
Utilization
 Fetal – Congenital infections, TORCH, Congenital
malformation, Multiple pregnancy, Trisomy 16, 21, 18.
Teratogens
 Anticonvulsants, Narcotics, Alcohol, Smoking, tobacco
Garbha vyapad
Diagnosis – Antenatal
 Poor maternal weight
gain
 < 2kg weight gain /
month in second half of
pregnancy
 Abdominal girth less (at
um)
 Fundal height lag in < 4
weeks suggestive of
moderate IUGR
 Fundal height lag in > 4
weeks suggestive of
severe IUGR
 Detailed serial Ultrasound – AC,
HC Doppler velocimetry –
Umbillical artery resistance,
placental infarction, placental
morphology
 Amniotic fluid Index
 TORCH
 Amniocentesis, Karyotyping
FH increase 1 cm / week between 14-32 weeks
Gravidogram
Abdominal girth – 1 inch / week after 30 weeks
30 inch at 30 weeks
Diagnosis –At birth
 Weight
 HC
 Dry wrinkled skin “old man
look”
 Thin umbilical cord
 Plantar creases well defined
 Baby alert
 Eyes open
 Reflexes normal
Complications
Fetal distress, hypoxia, acidosis
Immediate
 Asphyxia
 Hypoglycaemia
 Hypothermia
 Meconium aspiration
 RDS
 DIC
 Polycythemia
Late
 Lower intelligence
 Learning & Behavioral disorders
 Performance in school influenced
Assessment of fetal well being
Fetal biophysical profile – Manning score
 6-7 repeat within 24 hours
 <4 urgent delivery
Garbha vyapad
Fetal movement count
Management
 Adequate bed rest
 Correct malnutrition –
balanced diet – proteins
 Low dose aspirin – 50 mg
 Folic acid
 Left lateral position
 ANP – Atrial natriuretic
peptide
 Maternal oxygen therapy
 Glucocorticoids
 Monitoring

Termination
Mild Severe
Uncomplicated
Improve placental function Assess lung maturity
Aspirin, folic acid, ANP Steroid
Termination
IUGR
< 38
weeks
> 38
weeks
Ayurveda Management of IUGR
 Shatavari
 Phalghrit
 Masanumasik tablet
 Laghumalini vasant
 Kashmari ghrit
 Bala siddha ghrita
 Kshir basti
 Vata shunga siddha dugdha
 Nasya karma
 Brimhaniya gana siddha kshir pan and basti
Garbha vyapad
Garbha Shosha / Vatabhipanna garbha
 Dalhan
Garbha Nadi – Alpa rasa vahan and Akala bhojana – Chirena
Apyayate
8
Sanjatsaare – after 4th month
Pushpadarshanam – bleeding per vaginum


Samprapti
 Vagbhat – upavishtaka and upasushka
 Use of contraindicated articles causes bleeding per
vaginum – leads to aggravation of vata –
withholding pitta and sleshma
compresses rasa vaha nadi – obstruction of
nourishment to fetus – fetus does not grow
properly – eg of paddy.
Kuksi does not increase in size
Continues sphurana – quickening
Garbha vyapad
Etiology
 Observing fast
 Eating stale food
 Does not take fat
 Use of vata vitiating diet
 Dalhana – this occurs before 3 months of pregnancy
 Sushruta – Naigmesha


Signs and symptoms


 Fetus growth decreases
 Alpa Spandana
 Abdomen size decreases
Types of Upashushka and Upavishtaka
 Vata, pitta and kapha dominated symptoms in
Upavishtaka and upasushka
Time of delivery
 The fetus grow slowly through the teja of maternal diet.
 When they attain proper maturity they are
delivered.
She may even deliver after years
Because of prolonged stay – it delivers with teeth and hair
(INDU)
Treatment
 As described in Lina garbha
 Dhanyakuttana
 Diet – Vatahara, brimhana, madhura
 Followed by -
 Yana vahan
 Jrumbha
 Kshobha
Charak
 Vacha ghrita
 Mahapaisachika ghrita
 Gugguluvadi ghrita
 Amagarbha (egg)
 Jeevaniya, Brimhaniya vata hara siddhi ghrita
 Remain happy and cheerful
In absence of any growth – abortion should be induced by
use of pungent and purgative treatment given for
treatment of expulsion of placenta
Lina Garbha





Lina garbha
 Due to abnormalities of srotas caused by
complications of vayu, the fetus becomes
lina – adhered, this remains in the uterus
For a very long time and gets various
Complications.
Dalhana – death after prolong intra uterine
Stay
Absence of spandana - Vagbhat
Lina garbha Treatment
 Mridu Vaman, Virechana, Mridhu swedana snehana
 Yavaguu prepared with mamsa rasa (sea hawk)
 Kula masha tila bilva unripe (bilva shalatu) with wine
(madhvika ) for 7 days
 Massage of Kati frequently
 Mamsa of Bahira, Sikhi (peacock) fish with ghee
 Masha and Mulaka swarasa with ghee
 Dhanya kuttana, yanavahana
Mritagarbha – IUFD
Etiological factors

Etiological factors
 Vagbhatt
 Common causative factors of abortionand IUFD.
 Excessive accumulation of Doshas, the garbha is detached
like the fruit from its tree
 Deeds of previous life
 Nirahara
Causes (Ch. Sa. 8)
1. Excessive accumulation of doshas
2. Excessive use of pungent and hot
substances
3. Suppression of natural urges – defaecation,
micturition
4. Sitting, sleeping or standing at abnormal
or uneven surface
5. Compression or injury over abdomen
6. Anger, sorrow, jealousy, fear, excessive courage
Samprapti






Signs and symptoms

8

Treatment

Garbhashalya should either be treated with suppressive measures
As mentioned in treatment of retained placenta or with the use of
hymns mentioned in atharvaveda or should be extracted by
Experienced surgeon
After Shalya Karma
 For Garbhashaya shuddhi and Praharsha – Madhyapana
 Brimhana, Santarpana
 Sneha rahit yavagu
 Dipaniya, Jivaniya, Madhura Vatahara
Intra Uterine Fetal Demise (IUFD)
 Baby with no signs of life beyond 20 weeks, 24 weeks,
28 weeks weighing more than 500 gm
 Death at any time during pregnancy
 Still birth – no signs of life after 28th week
 WHO definition : Death prior to complete expulsion or
extraction of fetus during any week of pregnancy
 Types
 1. Early – 20-28 weeks
 2. Late - > 28 weeks
Still birth
 Still born infant which is viable
 No signs of life
Types of Still birth
1. Macerated
2. Fresh
Morbid pathology of IUFD
 A dead fetus undergoes an aseptic destructive process called
maceration. The epiderm is the first structure to undergo
the process, whereby blistering and peeling off of the skin
occur. It appears between 12-24 hours after death.
 The foetus becomes swollen and looks dusky red. Gradually
aseptic autolysis of the ligamentous structure and
liquefaction of the brain matter and other viscera take place.
Etiological factors
 Main cause is chronic placental insufficiency
 Pregnancy complications, Maternal illness, Fetal causes,
Iatrogenic, Idiopathic
 1. Pregnancy complications
Pre – eclampsia
Eclampsia
APH
Chorioamnionitis
Etiological factors
 2. Maternal Illness
Chronic HT
Obesity
Epilepsy
Trauma
Diabetes
Nephritis
APA, ACA
Syphillis
Hyperpyrexia
Severe Anaemia
Etiological factors
 3. Fetal causes
Congenital malformations
Multiple Pregnancy
IUGR
Post maturity
Infections
Rh incompatibility
Etiological factors
 4. Iatrogenic causes
Quinine
Version
Amniocentesis
5. Idiopathic – 20-30%
Diagnosis
Symptoms- Absence of foetal movements
Signs- Retrogression of the positive breast changes.
Per-abdomen-
- Gradual retrogression of the height of the uterus
- Uterine tone is diminished
- Foetal movement are not felt during palpation.
- Foetal heart sound is not audible
Investigations-
- Straight- X-ray abdomen
- Spalding sign: Over laping of skull bones because of liquefaction of
brain matter
- It usually appears 7 days after I.U.F.D.
- Hyperflexion of the spine – Ball’s sign
because of loss of tone of neck muscles
- Appearance of gas shadow (Robert’s sign) : 12 hours
Garbha vyapad
Diagnosis (contd…)
 Sonography :
(a) Lack of all foetal motions (including cardiac)
(b) Oligohydramnios and collapsed cranial bones
 Haematological examination: Rh-typing, VDRL, Blood sugar
and urea
 Postmortem studies
 Cytogenetic study: In cases of congenital malformation of
IUGR
Maternal Complications
 Disseminated Intravascular Coagulopathy
 Decreased platelets
 Decreased fibrinogen
 Increased PT/PTT (Clotting times)
 Clinical bleeding / oozing from all sites
 Depression, Anxiety, Psychosocial
 Anxiety with future pregnancies
 May have repeat losses (depending on causes)
 Bleeding ---> can lead to DIC but may only require blood
product replacement
 Pain, Infection (similar to any other delivery)
Management
 If expectant management is planned:
 Await spontaneous onset of labour during the next four weeks
 Reassure the woman that in 90% of cases the fetus is
spontaneously expelled during the waiting period with
no complicatons.
 If platelets are decreasing, four weeks have
passed without spontaneous labour, fibrinogen
levels are low or the woman request it,consider
active management (induction of labour)
Management (contd…)
 If induction of labour is planned, assess the
cervix
 If the cervix is favourable (soft, thin, partly dilated) labour using oxytocin.
 If the cervix is unfavourable(firm, thick, closed) ripen the cervix.
 If spontaneous labor does not occur within four weeks,
platelets are decreasing and the cervix is unfavourable,
ripen the cervix.
Garbha vyapad
 Induction
 Prostaglandins vaginal (Misoprost)
 Oxytocin 5 – 10 units in 500 ml of 5% Dextrose 15-20 drops
/ min
 Caesarean section
 Bromocriptine 2.5 mg BD for 10 days

Más contenido relacionado

La actualidad más candente

prasuti tantra & stri roga Syllabus PPT
prasuti tantra & stri roga Syllabus PPTprasuti tantra & stri roga Syllabus PPT
prasuti tantra & stri roga Syllabus PPTrajendra deshpande
 
Ayurvedic treatment principle in kaumarbhritya
Ayurvedic treatment principle in kaumarbhrityaAyurvedic treatment principle in kaumarbhritya
Ayurvedic treatment principle in kaumarbhrityaS.D.M.AYURVEDA, UDUPI
 
Concept of garbhadhan and garbha
Concept of garbhadhan and garbhaConcept of garbhadhan and garbha
Concept of garbhadhan and garbhaRitu Pandey
 
Comparative study of Sutika Dashmmola and Dashmoola Kwatha in well being of S...
Comparative study of Sutika Dashmmola and Dashmoola Kwatha in well being of S...Comparative study of Sutika Dashmmola and Dashmoola Kwatha in well being of S...
Comparative study of Sutika Dashmmola and Dashmoola Kwatha in well being of S...Pravin Rai
 
Uttara basti Indications & Contraindications
Uttara basti Indications & ContraindicationsUttara basti Indications & Contraindications
Uttara basti Indications & ContraindicationsAkshay Shetty
 
Introduction of kaumarbhritya
Introduction of kaumarbhritya Introduction of kaumarbhritya
Introduction of kaumarbhritya dobariyamiral
 
Ashta aartava dusti by rgesamc ron student
Ashta aartava dusti by rgesamc ron studentAshta aartava dusti by rgesamc ron student
Ashta aartava dusti by rgesamc ron studentMayank Parashar
 
Artava and modern aspects
Artava and modern aspectsArtava and modern aspects
Artava and modern aspectsAnuradha Roy
 
StanaRoga in Ayurveda with modern concepts of breast tumour and abscess
StanaRoga in Ayurveda with modern concepts of breast tumour and abscessStanaRoga in Ayurveda with modern concepts of breast tumour and abscess
StanaRoga in Ayurveda with modern concepts of breast tumour and abscessAnuradha Roy
 
Shukra dhatu |Shukra vigyan |
Shukra dhatu |Shukra vigyan | Shukra dhatu |Shukra vigyan |
Shukra dhatu |Shukra vigyan | Dr. Ayurveda
 
Concept of tridosha, dhatu,upadhatu,agni,panchamahabhuta in relation to
Concept of tridosha, dhatu,upadhatu,agni,panchamahabhuta in relation toConcept of tridosha, dhatu,upadhatu,agni,panchamahabhuta in relation to
Concept of tridosha, dhatu,upadhatu,agni,panchamahabhuta in relation toDr.Shruthi Arun
 
General introduction and scope of kaumarbhritya
General introduction and scope of kaumarbhrityaGeneral introduction and scope of kaumarbhritya
General introduction and scope of kaumarbhrityaDr. Vijay Kumar Pathak
 
Garbha Sambhav Samagri.ppt
Garbha Sambhav Samagri.pptGarbha Sambhav Samagri.ppt
Garbha Sambhav Samagri.pptssusera6ee4e
 
Sthaanika chikitsa in prasuti stri roga
Sthaanika chikitsa in prasuti stri rogaSthaanika chikitsa in prasuti stri roga
Sthaanika chikitsa in prasuti stri rogaAkhila A K
 

La actualidad más candente (20)

prasuti tantra & stri roga Syllabus PPT
prasuti tantra & stri roga Syllabus PPTprasuti tantra & stri roga Syllabus PPT
prasuti tantra & stri roga Syllabus PPT
 
Ayurvedic treatment principle in kaumarbhritya
Ayurvedic treatment principle in kaumarbhrityaAyurvedic treatment principle in kaumarbhritya
Ayurvedic treatment principle in kaumarbhritya
 
Dushi visha
Dushi vishaDushi visha
Dushi visha
 
Concept of garbhadhan and garbha
Concept of garbhadhan and garbhaConcept of garbhadhan and garbha
Concept of garbhadhan and garbha
 
Garbhini vyapad new
Garbhini vyapad newGarbhini vyapad new
Garbhini vyapad new
 
Comparative study of Sutika Dashmmola and Dashmoola Kwatha in well being of S...
Comparative study of Sutika Dashmmola and Dashmoola Kwatha in well being of S...Comparative study of Sutika Dashmmola and Dashmoola Kwatha in well being of S...
Comparative study of Sutika Dashmmola and Dashmoola Kwatha in well being of S...
 
Uttara basti Indications & Contraindications
Uttara basti Indications & ContraindicationsUttara basti Indications & Contraindications
Uttara basti Indications & Contraindications
 
Lehana
LehanaLehana
Lehana
 
Introduction of kaumarbhritya
Introduction of kaumarbhritya Introduction of kaumarbhritya
Introduction of kaumarbhritya
 
Ashta aartava dusti by rgesamc ron student
Ashta aartava dusti by rgesamc ron studentAshta aartava dusti by rgesamc ron student
Ashta aartava dusti by rgesamc ron student
 
Question bank 3rd year
Question bank 3rd yearQuestion bank 3rd year
Question bank 3rd year
 
Artava and modern aspects
Artava and modern aspectsArtava and modern aspects
Artava and modern aspects
 
StanaRoga in Ayurveda with modern concepts of breast tumour and abscess
StanaRoga in Ayurveda with modern concepts of breast tumour and abscessStanaRoga in Ayurveda with modern concepts of breast tumour and abscess
StanaRoga in Ayurveda with modern concepts of breast tumour and abscess
 
Ritucharya
RitucharyaRitucharya
Ritucharya
 
Shukra dhatu |Shukra vigyan |
Shukra dhatu |Shukra vigyan | Shukra dhatu |Shukra vigyan |
Shukra dhatu |Shukra vigyan |
 
Concept of tridosha, dhatu,upadhatu,agni,panchamahabhuta in relation to
Concept of tridosha, dhatu,upadhatu,agni,panchamahabhuta in relation toConcept of tridosha, dhatu,upadhatu,agni,panchamahabhuta in relation to
Concept of tridosha, dhatu,upadhatu,agni,panchamahabhuta in relation to
 
General introduction and scope of kaumarbhritya
General introduction and scope of kaumarbhrityaGeneral introduction and scope of kaumarbhritya
General introduction and scope of kaumarbhritya
 
Sootikopachara
SootikopacharaSootikopachara
Sootikopachara
 
Garbha Sambhav Samagri.ppt
Garbha Sambhav Samagri.pptGarbha Sambhav Samagri.ppt
Garbha Sambhav Samagri.ppt
 
Sthaanika chikitsa in prasuti stri roga
Sthaanika chikitsa in prasuti stri rogaSthaanika chikitsa in prasuti stri roga
Sthaanika chikitsa in prasuti stri roga
 

Similar a Garbha vyapad

Early pregnancy bleeding .ppt by Dr. Rabirra
Early pregnancy bleeding .ppt by Dr. RabirraEarly pregnancy bleeding .ppt by Dr. Rabirra
Early pregnancy bleeding .ppt by Dr. RabirraDrRabirraWaktola
 
Abortion-spontaneous miscarriage
Abortion-spontaneous miscarriageAbortion-spontaneous miscarriage
Abortion-spontaneous miscarriageKenson P Kanesious
 
Misscarage and recurrent miscarriage .pptx
Misscarage and recurrent miscarriage .pptxMisscarage and recurrent miscarriage .pptx
Misscarage and recurrent miscarriage .pptxlezan sorkan
 
Hemorrhage in early pregnancy / ABORTION
Hemorrhage in early pregnancy / ABORTIONHemorrhage in early pregnancy / ABORTION
Hemorrhage in early pregnancy / ABORTIONELIZEBETH RANI V
 
Abortion -what it is
Abortion -what it isAbortion -what it is
Abortion -what it isreagan phiri
 
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptx
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptxOBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptx
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptxmagie12
 
ANTEPARTUM_HAEMORRHAGE.pptx
ANTEPARTUM_HAEMORRHAGE.pptxANTEPARTUM_HAEMORRHAGE.pptx
ANTEPARTUM_HAEMORRHAGE.pptxugonnanwoke
 
Bleeding in early & late pregnancy
Bleeding in early  & late pregnancyBleeding in early  & late pregnancy
Bleeding in early & late pregnancyRabi Satpathy
 
GYNAE bleeding in a early pregnancy.docx
GYNAE  bleeding in a early pregnancy.docxGYNAE  bleeding in a early pregnancy.docx
GYNAE bleeding in a early pregnancy.docxchristinetoywa
 
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)College of Medicine, Sulaymaniyah
 
OBG - 14.5.20 AN UNIT - 7 ABORTION.pptx
OBG - 14.5.20 AN UNIT - 7  ABORTION.pptxOBG - 14.5.20 AN UNIT - 7  ABORTION.pptx
OBG - 14.5.20 AN UNIT - 7 ABORTION.pptxBasitRamzan1
 
Haemorrhage in early pregnancy
Haemorrhage in early pregnancyHaemorrhage in early pregnancy
Haemorrhage in early pregnancydrmohitmathur
 
POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD, Mob: 7289915430, w...
POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD,  Mob: 7289915430, w...POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD,  Mob: 7289915430, w...
POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD, Mob: 7289915430, w...Pradeep Garg
 
Bleedinginpregnancy 101105202812-phpapp01
Bleedinginpregnancy 101105202812-phpapp01Bleedinginpregnancy 101105202812-phpapp01
Bleedinginpregnancy 101105202812-phpapp01raajmalhotra
 
Bleeding in pregnancy
Bleeding in pregnancyBleeding in pregnancy
Bleeding in pregnancyNikky Church
 
2. ECTOPIC & MOLAR PREGNANCY.pptx
2. ECTOPIC & MOLAR PREGNANCY.pptx2. ECTOPIC & MOLAR PREGNANCY.pptx
2. ECTOPIC & MOLAR PREGNANCY.pptxMaximilianTUNGARAZA
 

Similar a Garbha vyapad (20)

Early pregnancy bleeding .ppt by Dr. Rabirra
Early pregnancy bleeding .ppt by Dr. RabirraEarly pregnancy bleeding .ppt by Dr. Rabirra
Early pregnancy bleeding .ppt by Dr. Rabirra
 
Abortion-spontaneous miscarriage
Abortion-spontaneous miscarriageAbortion-spontaneous miscarriage
Abortion-spontaneous miscarriage
 
Misscarage and recurrent miscarriage .pptx
Misscarage and recurrent miscarriage .pptxMisscarage and recurrent miscarriage .pptx
Misscarage and recurrent miscarriage .pptx
 
Hemorrhage in early pregnancy / ABORTION
Hemorrhage in early pregnancy / ABORTIONHemorrhage in early pregnancy / ABORTION
Hemorrhage in early pregnancy / ABORTION
 
Abortion -what it is
Abortion -what it isAbortion -what it is
Abortion -what it is
 
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptx
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptxOBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptx
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptx
 
ANTEPARTUM_HAEMORRHAGE.pptx
ANTEPARTUM_HAEMORRHAGE.pptxANTEPARTUM_HAEMORRHAGE.pptx
ANTEPARTUM_HAEMORRHAGE.pptx
 
Bleeding in early & late pregnancy
Bleeding in early  & late pregnancyBleeding in early  & late pregnancy
Bleeding in early & late pregnancy
 
GYNAE bleeding in a early pregnancy.docx
GYNAE  bleeding in a early pregnancy.docxGYNAE  bleeding in a early pregnancy.docx
GYNAE bleeding in a early pregnancy.docx
 
Abortion .pptx
Abortion .pptxAbortion .pptx
Abortion .pptx
 
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
Gynecology 5th year, 3rd & 4th lectures (Dr. Muhabat Salih Saeid)
 
OBG - 14.5.20 AN UNIT - 7 ABORTION.pptx
OBG - 14.5.20 AN UNIT - 7  ABORTION.pptxOBG - 14.5.20 AN UNIT - 7  ABORTION.pptx
OBG - 14.5.20 AN UNIT - 7 ABORTION.pptx
 
ABORTION.pptx
ABORTION.pptxABORTION.pptx
ABORTION.pptx
 
abortion ...pptx
abortion ...pptxabortion ...pptx
abortion ...pptx
 
Haemorrhage in early pregnancy
Haemorrhage in early pregnancyHaemorrhage in early pregnancy
Haemorrhage in early pregnancy
 
POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD, Mob: 7289915430, w...
POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD,  Mob: 7289915430, w...POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD,  Mob: 7289915430, w...
POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD, Mob: 7289915430, w...
 
Bleedinginpregnancy 101105202812-phpapp01
Bleedinginpregnancy 101105202812-phpapp01Bleedinginpregnancy 101105202812-phpapp01
Bleedinginpregnancy 101105202812-phpapp01
 
Bleeding in pregnancy
Bleeding in pregnancyBleeding in pregnancy
Bleeding in pregnancy
 
2. ECTOPIC & MOLAR PREGNANCY.pptx
2. ECTOPIC & MOLAR PREGNANCY.pptx2. ECTOPIC & MOLAR PREGNANCY.pptx
2. ECTOPIC & MOLAR PREGNANCY.pptx
 
Bleeding in early pregnancy
Bleeding in early pregnancyBleeding in early pregnancy
Bleeding in early pregnancy
 

Último

DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 

Último (20)

DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 

Garbha vyapad

  • 1. GARBHA VYAPAD Dr Jasmine Gujarathi Prof & Head Dept of Prasuti tantra and Stri roga G J Patel Institute of Ayurveda Studies and Research New Vallabh Vidyanagar Anand, Gujarat
  • 3.  Upavishtaka  Nagodara  Makkal  Mudhagarbha  Gudhagarbha  Vishkambha  Jarayu  Garbha pata
  • 4.  Abortion  IUGR  IUD  Obstructed labour
  • 6. Nidana – etiological factors  
  • 11.    Psychological stress, fear, strain with physical or any external trauma can cause death  This description is given in Mritagarbha
  • 12. 1. Abnormalities in the factors responsible for proper growth and development of fetus – can cause IUD or preterm labour 2.After fourth month of pregnancy – Anger, grief, jealousy, fear, excessive coitus, exercise, irritation, supression of natural urges, sitting – standing and sleeping on uneven place, abnormal postures, suppression of thirst and hunger, use of stale food and bleeding per vagina.
  • 13. 3. According to sushrut, etiology of mudhagarbha and garbhastrava pata are same Coitus, travelling, riding on horse, falling from height, trauma, suppresssion of natural urges, hot or pungent diet, grief, diarrhoea, excessive use of kshara, emetics and purgatives, indigestion and use of abortificient drugs. Krimi, vata and aghata – example of fruit As it gets detached in the similar way fetus gets detached due to above factors.
  • 14. 4. Vagbhatta – Due to excessive accumulation of doshas, non avoidance of contraindicated articles, due to diseases or deeds of previous life of either mother or fetus
  • 15. Samanya Lakshana – Clinical features
  • 16. ABORTION Definition:  Termination of pregnancy before 20-22-24 weeks of gestation  Or if the fetus weight < 500g  If > 24 w & > 500 g ➔ ~ premature labour  Abortus
  • 17.  Abortion occurring without medical or mechanical means to empty the uterus is referred to as spontaneous  Another widely used term is miscarriage
  • 19. Etiology  Fetal factors  Maternal factors  Paternal  Unknown  Trauma
  • 20. Fetal factors / Genetic factors  1. Chromosomal abnormality Autosomal trisomy (Down’s syndrome), Trisomy 16 Polyploidy Monosomy 2. Gross congenital abnormalitites 3. Blighted ovum 4. Knots in umbillical cord 5. Twin pregnancy
  • 21. Maternal factors 1. Maternal illness – a) Hypoxia – Chronic respiratory disease, anaemia, heart failure b) Chronic illness – hypertension, chronic nephritis, chronic wasting diseases
  • 23. Cervico – uterine factors (a) Cervical incompetence (b) Congenital malformation of uterus (c) Uterine tumor – fibroid (d) Retroverted uterus (e) Asherman’s syndrome
  • 24. (a) Infection – TORCH Toxoplasmosis Rubella Cytomegallo virus Herpes simplex Malaria, protozoal infection,
  • 25. Immunological factors – Antiphospholipid antibody syndrome Lupus Anticoagulant Human Leucocyte Antien Blood group incompatibility – Rh Incompatibility, ABO incompatibility
  • 27. Trauma  Direct injury  Journey  P/v Examination in susceptible invididuals  Psychic shock
  • 28. Iatrogenic  Amniocentesis  Cordocentesis  CVS  Radiation  Quinine  Warfarin  Ergot derivatives  Prostaglandins  Cytotoxic drugs
  • 29. Deficiency  Folic acid  Vitamin A  Vitamin E
  • 32. Pathology Hemorrhage into the decidua basalis, followed by necrosis of tissues adjacent to the bleeding If early, the ovum detaches, stimulating uterine contractions that result in its ovulation Gestational sac is opened , fluid surrounding a small macerated fetus or alternatively no fetus is visible → blighted ovum
  • 33. Categories of spontaneous abortion  Threatened abortion  Inevitable abortion  Complete abortion  Incomplete abortion  Missed abortion  Recurrent abortion
  • 35. Threatened abortion  Definition  The process of abortion has started but has not progressed to state from which the recovery is impossible.  Bleeding is frequently slight, but may persist for days or weeks  Frequency  Extremely common (one out of four or five pregnant women)  Symptoms  Usually bleeding begins first, brisk, brownish or bright red in colour  Dull abdominal pain follows a few hours to several days later, backache  Presence of bleeding & pain → Poor prognosis for pregnancy continuation Categories of spontaneous abortion
  • 36. Threatened abortion  Examination  P/s – Bleeding through external os, bright red  P/v – closed os Uterus – soft, size corresponds to period of amenorrhoea  Investigations USG / TVS Blood grouping Serum progesterone - > 25 ng/ml Treatment  Bed rest  Progesterone (IM)  Rh-negative women with threatened abortion should receive anti-D immunoglobulin Categories of spontaneous abortion
  • 37. Threatened abortion  Treatment :  Vaginal sonography  Serial serum quantitative hCG  Serum progesterone → can help ascertain if the fetus is alive & its location  Gestational sac(+) & hCG < 1000mIU/ml → gestation is not likely to survive → If any doubt(+), check the serum hCG level at intervals of 48hrs → if not increase more than 65%, almost always hopeless  Serum progesterone value < 5 ng/ml → dead conceptus Categories of spontaneous abortion
  • 39. Inevitable abortion  Definition : The changes of abortion have progressed to a state from which the continuation of pregnancy is impossible.  Clinical features : Threatened abortion + Increased vaginal bleeding Aggravation of pain - colicky General condition detoriates with increased bleeding  P/v Examination - Internal examination reveals dilated os through which the product of conceptus are felt Categories of spontaneous abortion
  • 41.  Management – Improve general condition Accelerate process of expulsion Maintain asepsis Before 12 weeks – D&C After 12 weeks – Oxytocin – accelerate uterine Contraction (10 units in 500 ml RL or NS 40-60 drops per minute)
  • 43. Follow up  Iron supplementation  Contraceptive  Investigations
  • 44. Complete abortion  Following complete detachment & expulsion of the conceptus Clinical features Subsidence of abdominal pain No bleeding P/v examination –  Uterus firm, smaller than period of amenorrhoea  The internal cervical os closes USG – empty uterus Treatment : Hematinics, Anti D, Antibiotics Categories of spontaneous abortion
  • 45. Incomplete abortion  Expulsion of some but not all of the products of conception during 1st half of pregnancy  The internal cervical os remains open & allows passage of blood  Clinical features 1. Continuation of pain and bleeding  Examination P/s – Uterus is smaller than period of amenorrhoea Cervix dilated The mass expelled is incomplete
  • 46. Management  Resuscitation IV fluids  Evacuation under analgesia or anesthesia D&E  Tab Misoprost 200  Hematinics  Anti D  Antibiotics
  • 47. Missed abortion  Retention of dead fetus inside the uterus for variable period.  Pathology – Macerated or mummified, liquor absorbs – after 12 weeks  Before 12 weeks – Carneous mole / Fleshy mole  Repeated haemorrhages in choriodecidual space disrupt the villi from attachments.  Clotted blood is collected called as mole. Categories of spontaneous abortion
  • 48. Missed abortion  Clinical features  Persistence of brownish vaginal discharge  Subsidence of pregnancy symptoms  Retrogression of breast changes  Cessation of uterine growth  Examination –  P/s Cervix feels firm, uterus firm smaller then Amenorrhoea  No FHS on doppler
  • 49. Management  < 12 weeks  Medical management – Misoprost 800 Microgram vaginally – repeat after 24 hours  Suction evacuation  > 12 weeks  Prostaglandin  Oxytocin – 10- 20 units in 500 ml RL or NS 30 drops / min
  • 50.  Picture of laminaria Laminaria tent
  • 52. Septic Abortion Definition – Any abortion associated with clinical evidences of infection of the uterus and its contents is called septic abortion. Clinical criteria of septic abortion 1. Rise in temperature - 100.4 F 2. Offensive and purulent vaginal discharge 3. Lower abdominal pain and tenderness 4. Malaise
  • 53. Causes  Endogenous cause – Infection elsewhere, decreased immunity  Anaerobic, Aerobic  Exogenous or mixed – from outside – Antiseptic and aseptic precautions not taken, incomplete evacuation
  • 54. Clinical features  Temperature with chills and rigors  Tachycardia  Abdominal or chest pain  Diarrhoea, vomiting  P/s and P/v – Tenderness +++, purulent discharge
  • 55. Clinical grading  Grade I – Localized in uterus  Grade II – Adnexal structures – parametrium, ovaries, tubes, pelvic peritoneum  Grade III – Generalized peritonitis, endotoxic shock, jaundice, renal failure
  • 56. Investigations  Cervical or vaginal swabs for culture  Blood tests with coagulation profile  Urine analysis  USG
  • 57. Prevention and Management  Prevention  Contraceptive use  Legalized abortion  Aseptic precautions during induction and management
  • 58. Management of septic abortion  Hospitalization  Grade I  Antibiotics  Prophylactic antigas gangrene serum and antitetanus serum  Analgesics and sedatives  Evacuation 24 hours after antibiotics  Grade II  Antibiotics & supportive treatment  Colpotomy wit suction evacuation  Grade III  Antibiotics  ICU  Laparotomy / Hysterectomy
  • 59. Recurrent Abortion Definition  Three or more consecutive pregnancy losses  Affects 1% of fertile couples
  • 63. Definitions . . .  Induced Abortion: intentional medical or surgical termination of a pregnancy  Elective: if performed for a woman’s desires  Therapeutic: if performed for reasons of maintaining health of the mother
  • 64.  In India the abortion was legalized by Medical Termination of Pregnancy Act – 1971., enforced in April 1972 revised in 1975……. MEDICAL TERMINATION OF PREGNANCY REGULATIONS, 2003 Done by registered medical practitioner
  • 65. Indications 1.Continuation of pregnancy would involve serious risk of life or grave injury to the physical and mental health of pregnant woman. 2. Risk of child being born with serious physical and mental abnormalities 3. When the pregnancy is caused by rape, both in cases of minor or major girl and in mentally imbalanced woman. 4. Failure of contraceptive
  • 66. First Trimester Abortion  Early Uterine Evacuation (EUE), Minisuction, Menstrual Regulation  Suction Abortion, Vacuum Curettage  Medical Abortion
  • 67. Minisuction / Menstrual Extraction  Introduced in 1972 by Karman and Potts
  • 68. Minisuction  Requires early recognition of pregnancy. Performs abortions up to 7-8 weeks from LMP  Cervical dilation not required, 6 mm diameter cannula used  Simplest, safest, least expensive  examine aspirated tissue is essential
  • 71. Medical Abortion  Mifepristone (RU486)  analogue of progestin  strong affinity for the progesterone receptor acting as an antagonist  a single oral dose given to women 5 weeks or less produces abortion in 85% of cases
  • 72. Mifepristone protocol  Women less than 49 days LMP with confirmed b-hCG  600mg mifepristone on day 1  On day three, return for prostaglandin, Misoprost 400 mcg orally  Patient remain in clinic four hours, during which time expulsion of pregnancy usually occurs
  • 73. Alternative Regimens  200 mg Mifepristone  800 mcg Mistoprostil vaginally
  • 74. MEDICAL ABORTIONS  The advantages  The procedure is non-invasive; no surgical instruments are used.  Anesthesia is not required.  Drugs are administered either orally or by injection.  The procedure resembles a natural miscarriage
  • 75.  Disadvantages  The effectiveness decreases after the seventh week.  The procedure may require multiple visits to the doctor.  Bleeding after the abortion lasts longer than after a surgical abortion.  The woman may see the contents of her womb as it is expelled
  • 76. Side effects  Excessive bleeding  Nausea  Vomiting  Headache  Diarrhoea  Backache  Abdominal pain  Anxiety  Loss of appetite  Incomplete abortion
  • 77. Dilatation and curettage (D&C)  Removal of pregnancy contents by some mechanical means  Vacuum most commonly used  12-13 weeks is the upper limit of gestational age
  • 78. D&C (vacuum curettage)  The cervix must be dilated to permit larger diameter suction curettes  Premedication with NSAID  Local (paracervical block), spinal, conscious sedation, or general anesthesia
  • 88. Intrauterine injection of abortificient  Prostaglandin, hypertonic saline, hypertonic urea are introduced by amniocentesis  Fetus and placenta are aborted vaginally  Osmotic dilators are used to decrease time to delivery and decrease complications
  • 89.  Picture of laminaria Laminaria tent
  • 91. Hysterotomy  Surgical method to remove pregnancy abdominally (mini-cesarean section)  Other methods are preferred
  • 92. Complications - immediate  Complications of local anesthetic  Cervical shock  Cervical lacerations  Uterine perforation  Hemorrhage
  • 93. Complications - delayed  Bleeding  retained products  Infection  Continued pregnancy  ectopic  intrauterine
  • 94. Samanya Lakshana – Clinical features
  • 95.  Pain in uterus, sacral, groin region and over the urinary bladder along with bleeding (Su.sa.10) This pain is due to vitiation of vayu and bleeding Is due to expulsion of ‘ama garbha’ and opening of orifices of ‘artava vaha srotas’
  • 97.  Shotha  Apatanaka  Arsha  Vedana  Pain with or without bleeding  Excessive bleeding  Retention of urine  Burning sensation etc.
  • 98. Treatment  Before 3 months – Ajatsara / Ama garbha / Virrudhaupakrama (if bleeding starts due to faulty dietary habits of mother, it will be difficult to cure)  After 4th month – Garbha sthapana chikitsa
  • 99.  Treatment of abortion of ama-garbha Before expulsion 1. Ruksha and shita treatment 2. After observing fast, decoction made from duralabha, amrita, ushira, parpataka chandana, ativisha, bala, dhanyaka 3. Trina dhanya and Sali or shastika rice in the form of peya or solid diet.
  • 100. 4. Yusha prepared from mudga etc for digestion of ama After digestion of ama – Snigdha, shita karma After expulsion 1. Madhya pana – for complete evacuation of uterus and relief of pain
  • 101. 2. Langhupanchamula siddha ruksha peya (without Sneha) 3. Amadhyapa – Yavagu made from Tila and uddalaka, with Pachaka dravyas, salt and fat free. 4. Peya made from Brihata panchamula with panchakola kalka (2 months = 2 days)
  • 102.  In case of incomplete expulsion of ama garbha Tikshna dravyas are used till complete Expulsion ➢ For treatment of abdominal pain after garbha pata – use of Arishta
  • 103.  After complete expulsion of ama garbha 1 Snehapana 2. Basti 3. Diet consisting of appetizing, digestive, jivaniya, sweet and vatahara dravyas
  • 104. Treatment of threatened abortion  External medications 1. Yoni pichu – Ghee + Yashtimadhu, Kshir 2. Lepa – shatdhauta ghrita / sahastra dhaut below umbillicus 3. Parisechan – Below umbillicus by Decoction of Yashtimadhu or nagrodhadhi gana or cow’s milk
  • 105. 4. Avagahan – cold water 5. Nyagrodhadhi gana – siddha taila pichu 6. Root of kantaki – tie around waist 7. Abhyanga by lakshadi oil
  • 106.  Internal medications 1. Garbhasthapana gana 2. Pumsavana karma 3. Nyagrodhadi gana – Shunga + Kshir sarpi 4. Jeevaniya gana sadhita kshir or shasti shali 5.
  • 107. Monthwise treatment of abortion First month Madhuka, Shakabija, Payasya, Surdaru Second month Ashmantak, Krishna tila, Tamravalli,(Manjistha) Shatavari Third month Vrikshadani, payasya, Priyangu, Utpal, Sariva
  • 108. Fourth month Ananta, Sariva, Rasna. Padma, Madhuka Fifth month Brihati dwaya, Kashmari, Kshirishunga Sixth month Prishnaparni, Bala, Shigru, Gokshura, Madhuparnika
  • 109. Seventh month Shringatak, Draksha, Kasheru, Madjuka, Sugar Eighth month Kapitha, Bilva, Brihati, Patol, Ikshu, Nidigdhika Ninth month Ananta, Sariva, Payasya, Yashtimadhu Tenth month Sunthi and payasya
  • 110.  Varanabandh –  Kashyap samhita - Revati kalpadhyaya
  • 112. Garbha Shosha / Vatabhipanna garbha  Dalhan Garbha Nadi – Alpa rasa vahan and Akala bhojana – Chirena Apyayate
  • 113. Treatment 1. Ruksha to be avoided 2. Brimhaniya drugs, milk and meat soup 3. Milk treated with Madhuyashti, sariva, Kashmari 4. Meat soup of carnivorous animals with brimhaniya drugs 5. Use of milk
  • 114. IUGR  Intra uterine growth retardation  Intra uterine growth restriction
  • 115. ◼ Foetal growth restriction ◼ Small for gestational age (SGA) ◼ 'wasted' and 'stunted' Intra Uterine Growth Retardation ◼ Intra Uterine Growth Restriction
  • 116. Definition  Birth weight less than 10th percentile of those born at same GA ◼ Low birth weight (LBW) means a baby with a birth weight of less than 2500Gms, which could be due to IUGR or Prematurity
  • 119.  < 1 Kg ELBW  < 1.5 Kg VLBW  < 2.5 Kg LBW  < 10th Percentile – SGA  10th to 90th Percentile – AGA  > 90th Percentile – LGA
  • 120. Normal Fetal Growth  1st phase – 4th week to 20th week Hyperplasia – 5gms / day  2nd Phase – 20 to 28th week Hyperplasia and Hypertrophy – 15-20gms / day  3rd Phase – 28 to 40th week Hypertrophy + accumulation of fat 32 to 34 weeks – 30-35 gm / day
  • 121. Fetal growth has been divided into three phases. 1-cellular hyperplasia  2- hyperplasy & hypertrophy  3- hypertrophy  cell size  fat deposition  fetal weight as much as 200 G.r. per week.
  • 122. Classification/ Types of IUGR •Small and healthy •PI Normal, No riskSGA •Symmetrical •Assymetrical True/ Pathological IUGR
  • 123.  Pondrel index : Widely used measurement of infants relative thickness or fatness in relation with height or length.  PI = Est Ft Wt / FL3  8.3 normal  Rohrer’s Pondrel Index = BW X 100/ Height3
  • 124. Symmetrical (Type I) 20-30% Asymmetrical (Type II) 70-80% Early exposure Late exposure (> 28 weeks) TORCH, Chromosomal abnormalities, Chemical exposure Placental insufficiency – PIH, abruption, pre eclampsia Decrease in number of cell Cell size decreases Uniformly small fetus Ratio normal HC > AC PI – normal PI – abnormal Poor prognosis Good prognosis
  • 125. Type III Symmetrical + Asymmetrical  Initially symmetrical and later assymetrical  Associated with Hypertension and vascular disease  Worst prognosis Other Classification Early Onset – before 32 weeks Late Onset – after 32 weeks  Intrinsic  Extrinsic  Combined  Idiopathic
  • 126. Classification Symmetrical Asymmetrical baby's brain is abnormally large when compared to the liver. may occur when the foetus experiences a problem during later development the baby's head and body are proportionately small. may occur when the foetus experiences a problem during early development. In a normal infant, the brain weighs about three times more than the liver. In asymmetrical IUGR, the brain can weigh five or six times more than the liver.
  • 127. Normal growth  Availability of nutrients – Maternal nourishment  Transfer of nutrients – Placenta and cord  Utilization of nutrients – Fetal
  • 128. Etiology Availability  Maternal factors – Malnourishment – glucose, amino acids  Malabsorption syndrome  Constitutionally small  Maternal vascular disease  Cynotoic heart disease  Renal disease  Anaemia  Smoking, tobacco  Decreased oxygen
  • 129. Etiology Transfer  Placenta and cord abnormalities  Abruptions, infarcts, small placenta, other placental abnormalities  PIH, Pre eclampsia, DM  Placenta praevia  Cord – knots, compression, etc
  • 130. Etiology Utilization  Fetal – Congenital infections, TORCH, Congenital malformation, Multiple pregnancy, Trisomy 16, 21, 18.
  • 131. Teratogens  Anticonvulsants, Narcotics, Alcohol, Smoking, tobacco
  • 133. Diagnosis – Antenatal  Poor maternal weight gain  < 2kg weight gain / month in second half of pregnancy  Abdominal girth less (at um)  Fundal height lag in < 4 weeks suggestive of moderate IUGR  Fundal height lag in > 4 weeks suggestive of severe IUGR  Detailed serial Ultrasound – AC, HC Doppler velocimetry – Umbillical artery resistance, placental infarction, placental morphology  Amniotic fluid Index  TORCH  Amniocentesis, Karyotyping FH increase 1 cm / week between 14-32 weeks Gravidogram Abdominal girth – 1 inch / week after 30 weeks 30 inch at 30 weeks
  • 134. Diagnosis –At birth  Weight  HC  Dry wrinkled skin “old man look”  Thin umbilical cord  Plantar creases well defined  Baby alert  Eyes open  Reflexes normal
  • 135. Complications Fetal distress, hypoxia, acidosis Immediate  Asphyxia  Hypoglycaemia  Hypothermia  Meconium aspiration  RDS  DIC  Polycythemia Late  Lower intelligence  Learning & Behavioral disorders  Performance in school influenced
  • 136. Assessment of fetal well being Fetal biophysical profile – Manning score
  • 137.  6-7 repeat within 24 hours  <4 urgent delivery
  • 140. Management  Adequate bed rest  Correct malnutrition – balanced diet – proteins  Low dose aspirin – 50 mg  Folic acid  Left lateral position  ANP – Atrial natriuretic peptide  Maternal oxygen therapy  Glucocorticoids  Monitoring
  • 141.  Termination Mild Severe Uncomplicated Improve placental function Assess lung maturity Aspirin, folic acid, ANP Steroid Termination IUGR < 38 weeks > 38 weeks
  • 142. Ayurveda Management of IUGR  Shatavari  Phalghrit  Masanumasik tablet  Laghumalini vasant  Kashmari ghrit  Bala siddha ghrita  Kshir basti  Vata shunga siddha dugdha  Nasya karma  Brimhaniya gana siddha kshir pan and basti
  • 144. Garbha Shosha / Vatabhipanna garbha  Dalhan Garbha Nadi – Alpa rasa vahan and Akala bhojana – Chirena Apyayate
  • 145. 8
  • 146. Sanjatsaare – after 4th month Pushpadarshanam – bleeding per vaginum
  • 148. Samprapti  Vagbhat – upavishtaka and upasushka  Use of contraindicated articles causes bleeding per vaginum – leads to aggravation of vata – withholding pitta and sleshma compresses rasa vaha nadi – obstruction of nourishment to fetus – fetus does not grow properly – eg of paddy.
  • 149. Kuksi does not increase in size Continues sphurana – quickening
  • 151. Etiology  Observing fast  Eating stale food  Does not take fat  Use of vata vitiating diet  Dalhana – this occurs before 3 months of pregnancy  Sushruta – Naigmesha  
  • 152. Signs and symptoms    Fetus growth decreases  Alpa Spandana  Abdomen size decreases
  • 153. Types of Upashushka and Upavishtaka  Vata, pitta and kapha dominated symptoms in Upavishtaka and upasushka
  • 154. Time of delivery  The fetus grow slowly through the teja of maternal diet.  When they attain proper maturity they are delivered. She may even deliver after years Because of prolonged stay – it delivers with teeth and hair (INDU)
  • 155. Treatment  As described in Lina garbha  Dhanyakuttana  Diet – Vatahara, brimhana, madhura  Followed by -  Yana vahan  Jrumbha  Kshobha
  • 156. Charak  Vacha ghrita  Mahapaisachika ghrita  Gugguluvadi ghrita  Amagarbha (egg)  Jeevaniya, Brimhaniya vata hara siddhi ghrita  Remain happy and cheerful
  • 157. In absence of any growth – abortion should be induced by use of pungent and purgative treatment given for treatment of expulsion of placenta
  • 159. Lina garbha  Due to abnormalities of srotas caused by complications of vayu, the fetus becomes lina – adhered, this remains in the uterus For a very long time and gets various Complications. Dalhana – death after prolong intra uterine Stay Absence of spandana - Vagbhat
  • 160. Lina garbha Treatment  Mridu Vaman, Virechana, Mridhu swedana snehana  Yavaguu prepared with mamsa rasa (sea hawk)  Kula masha tila bilva unripe (bilva shalatu) with wine (madhvika ) for 7 days  Massage of Kati frequently  Mamsa of Bahira, Sikhi (peacock) fish with ghee  Masha and Mulaka swarasa with ghee  Dhanya kuttana, yanavahana
  • 162. Etiological factors  Vagbhatt  Common causative factors of abortionand IUFD.  Excessive accumulation of Doshas, the garbha is detached like the fruit from its tree  Deeds of previous life  Nirahara
  • 163. Causes (Ch. Sa. 8) 1. Excessive accumulation of doshas 2. Excessive use of pungent and hot substances 3. Suppression of natural urges – defaecation, micturition 4. Sitting, sleeping or standing at abnormal or uneven surface 5. Compression or injury over abdomen 6. Anger, sorrow, jealousy, fear, excessive courage
  • 166.
  • 167. Treatment  Garbhashalya should either be treated with suppressive measures As mentioned in treatment of retained placenta or with the use of hymns mentioned in atharvaveda or should be extracted by Experienced surgeon
  • 168. After Shalya Karma  For Garbhashaya shuddhi and Praharsha – Madhyapana  Brimhana, Santarpana  Sneha rahit yavagu  Dipaniya, Jivaniya, Madhura Vatahara
  • 169. Intra Uterine Fetal Demise (IUFD)  Baby with no signs of life beyond 20 weeks, 24 weeks, 28 weeks weighing more than 500 gm  Death at any time during pregnancy  Still birth – no signs of life after 28th week  WHO definition : Death prior to complete expulsion or extraction of fetus during any week of pregnancy  Types  1. Early – 20-28 weeks  2. Late - > 28 weeks
  • 170. Still birth  Still born infant which is viable  No signs of life Types of Still birth 1. Macerated 2. Fresh
  • 171. Morbid pathology of IUFD  A dead fetus undergoes an aseptic destructive process called maceration. The epiderm is the first structure to undergo the process, whereby blistering and peeling off of the skin occur. It appears between 12-24 hours after death.  The foetus becomes swollen and looks dusky red. Gradually aseptic autolysis of the ligamentous structure and liquefaction of the brain matter and other viscera take place.
  • 172. Etiological factors  Main cause is chronic placental insufficiency  Pregnancy complications, Maternal illness, Fetal causes, Iatrogenic, Idiopathic  1. Pregnancy complications Pre – eclampsia Eclampsia APH Chorioamnionitis
  • 173. Etiological factors  2. Maternal Illness Chronic HT Obesity Epilepsy Trauma Diabetes Nephritis APA, ACA Syphillis Hyperpyrexia Severe Anaemia
  • 174. Etiological factors  3. Fetal causes Congenital malformations Multiple Pregnancy IUGR Post maturity Infections Rh incompatibility
  • 175. Etiological factors  4. Iatrogenic causes Quinine Version Amniocentesis 5. Idiopathic – 20-30%
  • 176. Diagnosis Symptoms- Absence of foetal movements Signs- Retrogression of the positive breast changes. Per-abdomen- - Gradual retrogression of the height of the uterus - Uterine tone is diminished - Foetal movement are not felt during palpation. - Foetal heart sound is not audible
  • 177. Investigations- - Straight- X-ray abdomen - Spalding sign: Over laping of skull bones because of liquefaction of brain matter - It usually appears 7 days after I.U.F.D. - Hyperflexion of the spine – Ball’s sign because of loss of tone of neck muscles - Appearance of gas shadow (Robert’s sign) : 12 hours
  • 179. Diagnosis (contd…)  Sonography : (a) Lack of all foetal motions (including cardiac) (b) Oligohydramnios and collapsed cranial bones  Haematological examination: Rh-typing, VDRL, Blood sugar and urea  Postmortem studies  Cytogenetic study: In cases of congenital malformation of IUGR
  • 180. Maternal Complications  Disseminated Intravascular Coagulopathy  Decreased platelets  Decreased fibrinogen  Increased PT/PTT (Clotting times)  Clinical bleeding / oozing from all sites  Depression, Anxiety, Psychosocial  Anxiety with future pregnancies  May have repeat losses (depending on causes)  Bleeding ---> can lead to DIC but may only require blood product replacement  Pain, Infection (similar to any other delivery)
  • 181. Management  If expectant management is planned:  Await spontaneous onset of labour during the next four weeks  Reassure the woman that in 90% of cases the fetus is spontaneously expelled during the waiting period with no complicatons.  If platelets are decreasing, four weeks have passed without spontaneous labour, fibrinogen levels are low or the woman request it,consider active management (induction of labour)
  • 182. Management (contd…)  If induction of labour is planned, assess the cervix  If the cervix is favourable (soft, thin, partly dilated) labour using oxytocin.  If the cervix is unfavourable(firm, thick, closed) ripen the cervix.  If spontaneous labor does not occur within four weeks, platelets are decreasing and the cervix is unfavourable, ripen the cervix.
  • 184.  Induction  Prostaglandins vaginal (Misoprost)  Oxytocin 5 – 10 units in 500 ml of 5% Dextrose 15-20 drops / min  Caesarean section  Bromocriptine 2.5 mg BD for 10 days