This case report describes the management of a 32-year old woman with intrauterine growth restriction (IUGR) using an Ayurvedic treatment regime. Key details include:
- The patient was 17 weeks and 6 days pregnant with decreased fetal movement and a fundal height not corresponding to gestational age, indicating suspected IUGR.
- She was treated with various Ayurvedic herbs like shatavari and medications to address the suspected cause of garbhakshaya (wasting of fetus).
- Despite treatment, subsequent ultrasounds showed evidence of fetal anomalies and growth restriction. The fetus was referred to a higher center for further management.
- The case report analyzes the Ay
1. MANAGEMENT OF IUGR BY AYURVEDIC
REGIME : A CASE REPORT
Dr. Bihani Sanjyal
PG. SCHOLAR
Department of PTSR
NIA, Jaipur
2. PATIENT’S PROFILE:
• Name : “X”
• Age : 32 years
• Husband’s age: 37 years
• Gender : Female
• Nationality : Indian
• Address : Jaipur, Rajasthan
• Religion : Sheikh
• Marital Status : Married since 15 years, broke first marriage after 14 years
of M.L., first year of second marriage
• Occupation : House wife
• Socio economic status : Middle Class
3. Chief complaints and progress of present
pregnancy
• Amenorrhea since 4 months
• Associated complaints : Backpain in lying position.
• History of present illness : - Patient was apparently well, but suddenly
missed her period for which she did UPT and found positive. She
came to NIA hospital OPD for routine ANC checkup . Since she had
lost her baby in last pregnancy , she was apprehensive and desirous
of medical care but due to her financial status she could not afford
expensive evaluation in this pregnancy.
4. Marital history and menstrual history
• Married life : 15 years , first marriage – broke after 14 years ml, then
second marriage since 1 year.
• Menstrual history :
• PMC: 3/28-30 days
• Pattern: regular
• Flow: normal
• Clots : absent
• Pain : absent
• Smell : absent
• LMP-3/3/2021
5. Obstetric history
• Gravida: 2
• Para : 1
• Abortion : one
• G1- Spontaneous abortion of 2.5 months gestation 12 years back for which
dilation and curettage was done. According to the patient fetus have some
sort of abnormality, documents not available with patient.
• G2- pp
• LMP: 3/3/2021
• EDD : 10/12/2021
• POG : 17 weeks 6 days
6. Medical and surgical history
• Dilatation and Curettage was done 12 years ago after spontaneous
abortion.
• No other previous medical and surgical illness
Family history : Husband had habit of taking alcohol and masala , gutka
7. Personal history
• Diet : Non-vegetarian
• Appetite : Normal
• Bowel habits :clear
• Micturition : clear
• Allergic history : none
• Addiction : not any
8. Clinical examination
GENERAL EXAMINATION :
• Built: Average
• Bp:110/70mmhg
• P.R: 76/min
• Ht. : 5ft
• Wt. : 65kg
• Pallor: mild+
• No evidence of thyroid enlargement
• Oedema: absent
• No evidence of lymphadenopathy
15. Advice
• Level 2 anomaly scan to R/O
CMF not done by patient party
• Blood test for
• HbsAg, SGOT, SGPT, S.bilirubin,
S.Alk.phos
• Continue iron and calcium
• Shatatvari churna 3gm BD with
milk
• Shalishastik 150gm with dadhi
17. Advice
• Color doppler USG for FWB
• This time patient willing to do and submit report next day
• USG on : 17/09/2021
• SLIU pregnancy with 28 weeks and 5 days , Breech presentation , FHS +, reg, 144/min
• AFI – adequate , 155mm
• Placenta-Ant., grade- I
• EFW -1356gm
• Cl-51mm
• IOS – closed
• Right uterine artery , fetal MCA, umbilical artery blood flow pattern normal, with no
evidence of uteroplacental umbilical fetal flow compromise , fetal aorta and DV shows
normal flow pattern
18. 4th visit on 22/10/2021
• Amenorrhea 8 months
• White discharge and itching
sensation in vagina .
• LMP: 3/3/2021
• EDD : 10/12/2021
• POG : 33wks 2days
• P/A : ut :28 to 30 wks
• Fundal height not corresponding to
Period of amenorrhea, FHS +,
• Pallor +
• Advice : LFT-alp : 163.2u/l ,
• Hb %- 8.9 g/dl
• Vaginal swab- candid albicans
• Suspected for IUGR and patient
was counselled accordingly.
• Treatment plan :
• Kheerbasti once in a week
• Tab Maxcal- c 1 bd
• Punarnava mandura 2 tab bd
• Liv. 52 1 tab bd
23. Probable Samprapti of Garbhakshaya
निदाि सेवि रसक्षय वातप्रकोप धातुक्षय गर्भक्षय
Manifestation of symptoms of Garbhakshaya
24. Causes and clinical features of Garbhasosh or
vatabhipanna garbha
• आहारमाप्िोनत यदा ि गर्भः शोषं समाप्िोनत पररस्रुनतं वा| तं स्त्री प्रसूते
सुचिरेण गर्ं पुष्टो यदा वषभगणैरपप स्त्यात ्||१५|| ि.शा.२/१५
• Lack of proper nourishment
• Continuous discharge of liquid/bleeding from vagina
• Cause Garbhasosh
• वाताभर्पन्ि एव शुष्यनत गर्भः, स मातुः क
ु क्क्षं ि पूरयनत मन्दं स्त्पन्दते ि
||सु.शा.१०/५७
• Due to vitiation of vayu, fetus dried up, does not fill properly to the
mothers abdomen and quivers very slowly.
• गर्े शुष्क
े तु वातेि बालािां िापप शुष्यताम ्||९५|| ि.चि. २८/९५
• If vata gets vitiated in garbhasaya , garbha gets dried up.
33. Posology of Ksheerbasti and oral medicine
administered
• KSHEER BASTI :
Gokshura churna : 5gm
Vidarikandha : 5gm
Bala churna :5gm
Putrajivak : 5gm
Milk- 15 parts – 300ml
Water – 15 parts -300ml
Ksheer basti was administered
once in a week
• Oral medication
• Phala ghrit
• Leptaden
• Shatavari churna
• Punarnava mandura
• Shalishastik
34. Name Latin name Rasa Guna Veerya Vipak Karma
GOKSHURA Tribulus terrestris
Linn.
Madhura Guru,
Snigdha
Sheeta Madhur
a
Mutral, Vrishya, Vatanut, Brumhana
VIDARI
(Tuberous
Root)
Pueraria tuberosa
DC.
Madhura Guru,
Snigdha
Sheeta Madhur
a
shukral, Balya, Mutrala, Pittahara,
Rasayana, Svarya, Vatahara,
Varnya, Stanyada, Jeevaniyaa,
Brumhaniyaa
BALA Sida cordifolia
Linn.
Madhura Snigdha Sheeta Madhur Jeevaniya, Brumhana, Balya, Medhya,
Rasayana, Prajasthapana, Shothaghna
Putrajivak Putranjiva
roxburghii Wall,
Drypetes
roxburghii (Wall.)
Hurusawa.
Madhur Guru, Picchill Madhur Sheeta Prabhav garbhakar, prajasthapan,
mutral, sothhara, trishnashamak,
anuloman
Drugs used in Ksheer Basti
35. Probable mode of action of ksheer basti
क्षीरपाक रसधातु
Fetal nourishment
with constructive
metabolism
36. Mode of action
• Ksheer basti by ita brimhan, balya and pustidayak property increases fetal
weight.
• Anabolic , nourishing and strengthening and rejuvenating effect .
• Basti has Vatanulomana effect so it normalizes the Vata , relieving back
ache, pain abdomen etc.
• Basti removes morbid wastes present in intestine and relieves constipation and
boost absorption of ksheer paak ingredients.
• क्षीराद्द्वौ प्रसृतौ कायौ मधुतैलघृतात्रयः| िजेि मचथतो बन्द्स्त्तवाभतघ्िो
बलवणभकृ त्||४|| ि.भस. ८/४
• Pancha prashritik basti
• Amount is 40 tola
• Specially designed for garbhini
37. Mechanism of drug absorption in rectal
mucosa
• Maximum absorption of drug – under the influence of lactose in the
distal small intestine via paracellular route
40. Result and Discussion
• Patient was given ksheer basti every week for 4 weeks
• Then USG was done to assess fetal growth
• Fetal weight was increased upto 2282gm
• But the fetus was having spina bifida myelomeningocele on USG
findings
• Patient was referred to maternity hospital where she delivered alive
female child of 2.3kg on 24/11/2021 through normal vaginal delivery.
• Child was born with myelomeningocele with Arnold chiari 2 brain
malformation
41.
42. First USG at 16 weeks
Color doppler at 27
weeks USG at 36 weeks