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

9. Systemic examination
• No abnormality detected

10. Obstetrical examination
Abdominal examination : since patient is in first month of pregnancy,
abdomen is soft, non tender.
Vaginal examination : not done

11. Antenatal visit in NIA
• First visit : she had her first ANC
visit on April 4, 2021
• Amenorrhea since 1 month
• LMP: 3/3/2021
• EDD : 10/12/2021
• POG : 4wks 3 days
• On Examination :
• Bp-110/70mmhg
• P.R. – 76/min
• Ht. 5ft
• Wt. 65kg
• Pallor: mild+
• Oedema : absent

12. Advice
• Routine ANC investigations
• USG for fetal well being
• Treatment :
• Shatavari churna 3 gm +godanti
bhasma 500mg bd with milk
• Gokshura churna 3gm bd
• Tab leptaden 2 tab BD
• Tab sensifol 1 OD

13. Second visit – 7/6/2021
• Amenorrhea 4 months
• Backpain in lying position
• LMP: 3/3/2021
• EDD : 10/12/2021
• POG : 17 wks 6 days
• O/E: Bp-110/70mmhg
• P.R. – 76/min
• Wt. 65kg
• Pallor: mild+
• Oedema : absent
• P/A : Fundal height not corresponding with
period of amenorrhea
• Ut: 18-20 weeks size , FHS+
• Usg findings : 29/6/2021-
• Single Live Intrauterine Fetus Of 17 Wks 2
Days +/- 8 Days
• Specific – mild ventriculomegaly
• Presentation – unstable
• Placenta – fundal grade 1
• Amniotic fluid – adequate
• FHS +nt , reg, 155b/min
• She had already done routine blood and urine
investigation , reports were found normal

14. Further investigations ??

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

16. 3rd visit-16/09/2021
• Amenorrhea 7 months
• Decreased fetal movement
• LMP: 3/3/2021
• EDD : 10/12/2021
• POG : 27wks 3days
• BP:110/70 mmhg
• P.R: 96/Min
• TPR: 98.2F
• P/A: ut: size 26 weeks , FHS +

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

19. Why fundal height was not corresponding to
POG??
Surprise

20. 5th visit on 16/11/2021
• 9 Months amenorrhea
• LMP: 3/3/2021
• EDD : 10/12/2021
• POG : 36wks 6days
• BP- 110/80 mmhg
• P.R- 88/Min
• TPR: 98.2F
• Weight : 66kg
• P/A: ut: size 34 weeks , FHS +,
cephalic
• USG done on 15/11/2021
• SLI ut. pregnancy of 33 weeks 2
days with lumbar spina bifida with
meningomyelocele, CHIARI-II brain
malformation, polyhydramnios
with IUGR
• EFW-2282gm
• AFI- increased -17.4cm
• Advice : referred to higher center
for further management

21. What may be the probable
diagnosis ??

22. • Diagnosis : GARBHAKSHAYA
• Conventional diagnosis : IUGR / SGA
• Differential diagnosis : Upavistak, Nagodhara, Garbhasosh,
Garbhakshaya, leena garbha

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.

25. निदाि
• पुिरुष्णतीक्ष्णोपयोगाद्गभर्भण्या महनत सञ्जातसारे गर्े पुष्पदशभिं
स्त्यादन्यो वा योनिस्रावस्त्तस्त्या गर्ो वृद्चधं ि प्राप्िोनत निःस्रुतत्वात ्; स
कालमवनतष्ठतेऽनतमारं, तमुपपवष्टकभमत्यािक्षते क
े चित्|ि.शा.८/२६

26. Clinical features of Garbhakshaya
• गर्भक्षये गर्ाभस्त्पन्दिमिुन्ितक
ु क्क्षता ि; || सु. सू .१५/१२
• Absence of quickening
• Decrease in fundal height

27. Causes of congenital malformation
• शुक्रस्त्य दोषात ् क्लैब्यमहषभणम्|
• रोचग वा क्लीबमल्पायुपवभरूपं वा प्रजायते||१८||
• ि िास्त्य जायते गर्भः पतनत प्रस्रवत्यपप|
• शुक्र
ं हह दुष्टं सापत्यं सदारं बाधते िरम्||१९|| ि. सू २८
• वायुस्त्तन्रयन्रधरः.... कताभगर्ाभकृ तीिाम् -प्राकृ त वायु

28. • यहद ि मिुष्यो मिुष्यप्रर्वः, कस्त्मान्ि जडाहदभ्यो जाताः
पपतृसदृशरूपा र्वन्तीनत; तरोच्यते- यस्त्य यस्त्य ह्यङ्गावयवस्त्य बीजे
बीज र्ाग उपतप्तो र्वनत, तस्त्य तस्त्याङ्गावयवस्त्य पवकृ नतरुपजायते,
िोपजायते िािुपतापात ्; तस्त्मादुर्योपपपिरप्यर| सवभस्त्य
िात्मजािीन्द्न्ियाणण, तेषां र्ावार्ावहेतुदैवं; तस्त्मान्िैकान्ततो जडाहदभ्यो
जाताः पपतृसदृशरूपा र्वन्द्न्त||१७|| cha. Sha.3/17
• Due to bikriti in beejansha various congenital abnormalities are seen.
• उपतप्तो-

30. Treatment principle
• According to Acharya sushruta
• गर्भक्षये गर्ाभस्त्पन्दिमिुन्ितक
ु क्क्षता ि; तर प्राप्तबन्द्स्त्तकालायाः
क्षीरबन्द्स्त्तप्रयोगो मेद्यान्िोपयोगश्िेनत ||१२||. सु.सू.१५/१२
• Use of ksheer basti in garbhakhsaya as per acharya sushruta
• वाताभर्पन्ि एव शुष्यनत गर्भः, स मातुः क
ु क्क्षं ि पूरयनत मन्दं स्त्पन्दते ि,
तं बृंहणीयैः पयोभर्मांसरसैश्िोपिरेत ् | सु.शा.१०/५७
• यस्त्याः पुिगभर्भः प्रसुप्तो ि स्त्पन्दते तां
श्येिमत्स्त्यगवयभशणिताम्रिूडनतपिरीणामन्यतमस्त्य सपपभष्मता रसेि माषयूषेण
वा प्रर्ूतसपपभषा मूलकयूषेण वा रक्तशालीिामोदिं मृदुमधुरशीतलं र्ोजयेत ्|
तैलाभ्यङ्गेि िास्त्या अर्ीक्ष्णमुदरबन्द्स्त्तवङ्क्षणोरुकटीपाश्वभपृष्ठप्रदेशािीषदुष्ण-
िोपिरेत्||२८|| ि. शा.८/२८

31. • र्ौनतकजीविीयबृंहणीयमधुरवातहरभसद्धािां सपपभषां पयसामामगर्ाभणां
िोपयोगो गर्भवृद्चधकरः ि. शा. ८/२७
• अष्टमे बदरोदक
े िबलानतबलाशतपुष्पापललपयोदचधमस्त्तुतैललवण-
मदिफल मधुघृतभमश्रेणास्त्थापयेत ् पुराणपुरीषशुद््यथभमिुलोमिाथं ि
वायोः, ततः पयोमधुरकषायभसद्धेि तैलेिािुवासयेत ्, अिुलोमे हह वायौ
सुिं प्रसूयते निरुपिवा ि र्वनत,सु. शा.१०/४

32. • Use of ksheer described in Kashyap Samhita

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

39. Clinical assessment
Assessment Visit 2 Visit 3 Visit 4 Visit 5
Pog 17 wks 6 days 27wks 3days 33 wks 2 days 36wks 6days
Bp 110/70 mmhg 110/70 mmhg 120/80 mmhg 110/80 mmhg
Pulse rate 76/min 96/min 84/min 88/min
Weight 65kg 65kg 64kg 66 kg
Pallor Mild Mild Mild Mild
Pedal oedema Absent Absent Absent Absent
Fundal height 18 wks size 26 wks 28-30 wks 34 wks
Fhs Present Present Present 136/min Present
Usg efbw 1356 gm 2282gm
AFI 155mm 17.4cm

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

42. First USG at 16 weeks
Color doppler at 27
weeks USG at 36 weeks

43. Normally delivered baby with mmc

47. • What ayurveda can offer to prevent congenital abnormalities ?

48. Thank you