Lecture on Non-Invasive Management of Pregnancy Bleeding-A Successful Case Report By- Dr. Anuradha Roy

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Non-invasive management of pregnancy bleeding- a successful case report

Dr. Anuradha Roy

Department of Prasuti Tantra, Faculty of Ayurveda, IMS; BHU, Varanasi.

Introduction: Pregnancy bleeding is an alarming sign which should be taken care of so as to rule out the cause of such bleeding. The pregnancy may remain viable (threatened abortion) in spite of bleeding or it may be a feature of non-viability (missed abortion/blighted ovum). The pregnancy may also be partly (inevitable/incomplete abortion) or completely expelled (complete abortion).

Abortion is quite a common counting about 15% of confirmed pregnancy. It causes a significant psychological and physical trauma. Thus counseling and psychological support is very important key point in the management of abortion.

Spontaneous abortion is often very complex and obscure in its etiological factors. Causes of abortion are usually divided into- ovular or fetal, maternal environment, paternal factor, unknown.

Patient Profile:

A 28 years old hindu female, second gravida with LMP on 26/08/2020 with a complaint of amenorrhoea of 3 months 08 days with vaginal bleeding (1pad/day) since 15 days off and on associated with general debility came to the OPD of Sir Sunderlal Hospital, Banaras Hindu University for proper management. She is a resident of Lanka, Varanasi city, married for 8 years. She had a FTND female of 7yrs.

Case history:

  • On General Examination her BP measured in OPD was 100/70 mmHg (in sitting position)
  • Routine investigations like CBC revealed Hb-10.6 gm/dl with normal platelet count.
  • Urine routine and microscopy examination reveals the presence of pus cells-2-3 /hpf and epithelial cells 3-5 cells/hpf.
  • Per abdomen examination does not reveal any other evidence.
  • Per vaginal examination was withheld to avoid undue handling of uterus considering the bleeding situation as USG is easily available.

Management:

  • The patient was counseled and advised to have complete bed rest with head in low position.
  • Light diet.
  • Supportive management as per ANC protocol given with Phala Ghrita 5 gms twice daily with lukewarm milk.
  • Local application- Gairika churna 5gms with Shatadhauta ghrita 15-20 gms in the form of lepa application twice- thrice a day.

Result:

  • Bleeding per vaginum was relieved completely in one week period. By the end of one week patient has reported no bleeding per vaginum.
  • Anointing lepa prepared with Shatadhauta ghrita and Gairika below the navel region is an effective non-invasive management in early pregnancy bleeding (Garbha- srava).

Discussion of the case with probable mode of action:

Gairika (Red ochre) which is having  vishada (clear), snigdha(unctous), kashaya (astringent), madhura (sweet) and hima (cold) properties (A.S.Su.12/20), sheeta virya and madhura vipaka which is classified under Shonitasthapana gana (Ca.Su.4/46) can act as Raktastambhaka (hemostatic) drug. According to Ashtanga Hridaya, Gairika comes under kashaya skanda. (A.H.10/32). It is one of the safest naturally occurring mineral mostly known for its Pittashamaka and Raktastambhaka properties (Su.Ci.5/8).

Shatadhouta ghrita is prepared by washing ghee for 100 times in cold water(Su.U.39/283,Dalhana). It is of light consistency and cooling  quality and homogeneous, smooth, non-oily product, which is easier to apply, thus improving the patient compliance as a base for topical application can also act as a Raktastambhaka drug. It was found that Shatadhouta ghrita exhibits a much less degree of unsaturation and better consistency and hence suitable for topical application. Shatadhouta ghrita after preparation becomes very sheeta (cold), sukshma (minute particles) and mrudu (soft) all these properties can cause sthambhana karma (Ca.Su.22/17).

In Shatadhouta ghrita, due to the continuous washing and pressure applied during rubbing, particle size of fat granules get reduced makes the product non sticky, homogeneous, with a large surface area, which make it easy to apply on skin and may result in increased rate of absorption through skin. Washing results in the formation of a homogeneous mass of oil in water emulsion with better consistency and viscosity which helps in its topical application.

When a Lepa is applied over the surface of skin opposite to the direction of hairs on it, through a proper base the active principles of the ingredients of Lepa are released into that base. After that this combination enters the Romakupa and further gets absorbed through the swedavahi srotas and siramukh (Su.Su.18/4). Then it reaches the desired site and pacifies the provoked dosha. Here the Lepa prepared with Shatadhouta ghrita and Gairika causes Raktastambhana by the stambhana action of both the drugs in the artavavaha srotas. Shatadhouta ghrita can act both as base and a sthambana dravya.

Conclusion:

In conclusion we can state that Ayurvedic medicine acts wonderfully in the management of early pregnancy bleeding. Moreover this combination of Shatadhouta ghrita and Gairika is a successful non- invasive method which not only is Shonitasthapana (haemostatics) also act as a Garbhasthana (fetus promoting) drug.

  • In Shatadhouta ghrita, due to the continuous washing and pressure applied during rubbing, particle size of fat granules get reduced makes the product non sticky, homogeneous, with a large surface area, which make it easy to apply on skin and may result in increased rate of absorption through skin.
  • In Shatadhouta ghrita, due to the continuous washing and pressure applied during rubbing, particle size of fat granules get reduced makes the product non sticky, homogeneous, with a large surface area, which make it easy to apply on skin and may result in increased rate of absorption through skin.
  • In Shatadhouta ghrita, due to the continuous washing and pressure applied during rubbing, particle size of fat granules get reduced makes the product non sticky, homogeneous, with a large surface area, which make it easy to apply on skin and may result in increased rate of absorption through skin.

MCQs

 

1.    The period of viability is considered to be

A.  24 weeks

B.  28 weeks

C.  30 weeks

D.  18 weeks

 

2.    Pregnancy may continue with which of the following pregnancy-

A.  Missed abortion

B.  Inevitable abortion

C.  Threatened abortion

D.  Incomplete abortion

 

3.    Legal abortion is a type of which abortion-

A.  Spontaneous abortion

B.  Induced abortion

C.  Recurrent abortion

D.  Septic abortion

 

4.    Which of the following has majority cause of abortion

A.  Ovular or fetal

B.  Maternal environment

C.  Paternal factor

D.  Unknown

 

 

5.    Deficiency of which factor is responsible for abortion

A.  Vit-C

B.  Vit-A

C.  Vit-B12

D.  Folic acid

6.    What may be the cause of abortion

A.  Diarrhoea

B.  Dysentery

C.  Hyperpyrexia

D.  Hyperemesis

7.    Major cause of first trimester abortion

A.  Cervical incompetence

B.  Defective germ plasm

C.  Trauma

D.  Environmental

8.    Major cause of mid trimester abortion

A.  Cervical incompetence

B.  Defective germ plasm

C.  Trauma

D.  Environmental

9.    Which local application is discussed in the present case

A.   Lepa

B.  Pana

C.  Basti

D.  Nasya

10.                 Shatadhauta ghrita is prepared by washing ….times with water.

A.  01

B.  20

C.  100

D.  1000

 

 

 

 

KEY to the MCQs

1. B
2. C
3. B
4. A
5. D
6. C
7. B
8. A
9. A
10. C

 

 

Supplementary Resources

 

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  2. Yadavaji Trikamaji & Narayan Ram (editor). Sushruta Samhitā of Sushruta with ‘Nibandhasangraha’ commentary by Dalhana. Chikitsasthana, chapter 37. Reprint edition, Varanasi: Chaukhamba Surbharati Prakashan;2003.
  3. Shivprasad Sharma (editor). Ashtānga Samgraha of Vriddha Vāgbhata with ‘Shashilekhā’ commentary by Indu. Sutrasthana, chapter 28. 1st edition, Varanasi: Chowkhamba Sanskrit Series Office; 2006.
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  7. Priya Vrat Sharma (editor), Bhela Samhita, with English translation, commentary and critical notes, Dr.K.H. Krishnamurthy, Reprint 2008, Varanasi, Chaukhambha Visvabharati 2008.
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  1. Self Assessment and Review Obstetrics by Sakshi Arora Hans, 12th edition, published by Jaypee The Health Sciences Publisher New Delhi, 2019

 

  1. Williams Obstetrics, edited by F Gary Cummingham, 24th edition published by MC Graw Hill Medical New York.

 

  1. Dewhurst’s Textbook of Obstetrics & Gynaecology, Eighth Edition, Editor(s): D. Keith Edmonds FRCOG, RRACOG, First published:5 January 2012 Print ISBN:9780470654576 |Online ISBN:9781119979449 |DOI:10.1002/9781119979449

 

  1. Oxford Handbook of Obstretrics and Gynaecology by Sally Collins, Sabaratnam Arulkumaran at all.  3rd (http://gynecology.sbmu.ac.ir/uploads/4_5841359559276364169.pdf)

 

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