ONE OF THE GARBHA VYAPAD DEALS WITH PROLONGED AND OBSTRUCTED LABOUR

1. Mudhagarbha
Dr Jasmine Gujarathi
Professor & Head
Dept of Prasuti tantra and Stri roga
G J Patel Institute of Ayurveda Studies and Research
New Vallabh Vidyanagar

2. Definition

3. Definition

4. Definition

5.  The descriptions of Mudhagarbha denotes obstructed labour
/ prolonged labour due to faults in power, passage or
passenger.
 Alive or dead fetus
 after attaining development of all body parts,
 after seventh month of pregnancy,
 presenting abnormally, and or in abnormal passage
associated with abnormal uterine contractions
 due to vitiation of Apana vayu is called Mudhagarbha

6. vivrudhdham
 Macrosomic foetus
 Polyhydramnios
 Conjoined twins
 Hydrocephalous
 Foetal ascitis
 Foetal meningoceles

7. Fetal malformation
7

10. Uterine inertia
 Diminished intensity
 Shortened duration
 Good relaxation in between two contractions
 Increased intervals
 P/A-Less hard uterus
 P/V-poor dilatation of cervix
-association of CPD, malpositions or mal
presentations

11. Anekadha pratipannnam
 Four bhedas of mudha garbha
 Astagathi of mudha garbha
 Trividha sanga
 Avaakmukha and jatarodaya of harita
 Asankhya gati
ALL TYPES OF MALPRESENTATIONS AND COMPOUND
PRESENTATIONS

12. Nidana

13. Samprapti







14. Urdhva – CPD
Tiryaka - Transverse
Nyubja - Breech

15. Lakshana

16. Bheda – Types
Kila
Pratikhura
Bijaka
Parigha

17. Kila -

18. Pratikhura

19. Bijaka

21. Parigha

22. Gati

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27. Frank breech
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Complete breech

30. Vishakambha

31. Asadhya Mudhagarbha

32. Asadhya Mudhagarbha

35. CHIKITSA SUTRA
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PREREQUISITES
 Consent
 Empty stomach
 Concept of sterilization

37. Shastra chikitsa siddhanta

38. Operative manipulations / procedures

39. Version
 Procedure designed to change the lie to being the
comparatively favourable pole to the lower pole of the
uterus
 External Cephalic
 Internal Podalic
 Bipolar

40. External version
 Indications : Breech, Transverse lie
 Success rate – 70=80%
 Time – 32 -34 weeks with tocolytics
 Contraindications – Pre eclampsia, placenta praevia, post
casarean, malformed uterus, contracted pelvis,
hydrocephalus, dead fetus, multiple pregnancy

43. External version

44. Complications
 Maternal – Injury, Rupture, PPH, Abruptio placenta
 Fetal – Hypoxia, trauma, fracture, cord entanglement,
knots

45. Internal version

47.  Internal version is always podalic version and it is
completed with extraction of fetus
 Indication – transverse lie second baby of twin
 Conditions – cx must be fully dilated, liquor sufficient,
fetus live
 Contraindications – obstructed labour, contracted pelvis

48. Achetana Mudhagarbha Chikitsa
siddhanta
The main principle in dead fetus is that whichever anga
(part) is causing obstruction should be cut and
extracted to save the mother.

49. One should not wait or neglect condition of woman to
detoriate, hence the fetus should be extracted
immediately.

50. Shastras used for moodagarbha nirharana

51. SASTRA USED TO EXTRACT THE
MUDHAGARBHA:
a. Mandalagra (circular knife or round
head knife, decapitating knife)
b. Angulisastra (finger knife)
c. Sanku (hook)
d. Ardhachandra (curved knife)

52. Destructive operations
 Designed to diminish the bulk of the fetus so as to
facilitate easy delivery through the birth canal.
 Not practiced because of severe injuries.
 In unorganized sector may have to perform

53. Destructive surgeries in moodhagarbha
 Craniotomy
 Evisceration
 Cleidotomy
 Decapitation

54. Craniotomy
 Indication – cephalic presesntation with obstructed labour
– dead fetus
 Hydrocephalus in live fetus
 Interlocking head of twins – dead
Contraindications – severe contracted pelvis
Rupture of uterus
Instrument used – oldham’s perforator / Mayo’s scissors

57. Decapitation
 Indication – neglected shoulder presentation where neck
is accessible
 Instrument used – decapitation hook / knife
 Evisceration – Removal of thoracic and or abdominal
contents
 Indications – shoulder presentation where neck is not
accessible , fetal ascitis, monsters

58.  Cleidotomy – division of one or both clavicle
 Indication – shoulder dystocia where clavicles are
accessible
 Instrument – embryotomy scissor

59. Post operative care
 Pippali, Pippali mula, Sunthi, ela, hingu, bharangi,
vacha, ativisha chavya – kalka / kwath / churna – with or
without ghee for 3, 5 or 7 days
 Snehapana
 Asava / Arishta at night
 Swedana and abhyanga
 Milk processed with vatahara dravyas for 10 days
 Brimhana – Mamsa rasa for 10 days
 Pathya ahara

60. Operation with dead mother and live fetus
Just like the killed goat, a woman dies during labour, with
quivering still persisting, immediately laprotomy should
be done to extract live fetus

62. THANK YOU