probable ayurvedic explaination of obstructed labour

1. Dr.Priya Sharma
PG Scholar
Deptt.Of P.G Studies In P.T.S.R
Batch -2010
02-02-2014
Dr.Priya Sharma, PG 2nd Year
1

2. • योननसमवरणम ् सन्ग् कऺौ मकल्ऱ एव च
ु
हन्य् स्त्रियं मड्.गर्भा यथोक्तश्चभप्यऩद्रवभ्(M.N
ु
ू
ु
64/10)
• In this verse, Madhavakara talks about
ASADHYA MOODA GARBHA
LAKSHANAS.
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Dr.Priya Sharma, PG 2nd Year
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3. • qÉÔRû: MüUÉãÌiÉ mÉuÉlÉ: ZÉsÉÑ qÉÔRû aÉpÉïqÉç|| (qÉÉ0 ÌlÉ0, pÉÉ0
mÉë0, rÉÉã0 U0)
• qÉÔRûÉã urÉÉxÉ£ü aÉÌiÉ: | qÉkÉÑMüÉãvÉ urÉZrÉÉ
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Dr.Priya Sharma, PG 2nd Year
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4. • iÉqÉåuÉ
MüSÉÍcÉiÉçÌuÉuÉ×®qÉxÉqrÉaÉÉaÉiÉqÉmÉirÉmÉjÉqÉlÉÑmÉëÉmiÉqÉÌlÉUxrÉqÉÉlÉÇ
ÌuÉaÉÑhÉÉmÉÉlÉqÉÉåÌWûiÉÇ aÉpÉïÇ qÉÔRûaÉpÉïÍqÉirÉÉcɤÉiÉå ||
(xÉÑ.ÌlÉ.8/3)
• iÉÇ iÉÑ aÉpÉïÇ MüSÉÍcÉSxÉqrÉaÉmÉirÉmÉjÉqÉlÉåMükÉÉ mÉëÌiÉmɳÉÇ ÌuÉaÉÑhÉålÉ
uÉÉrÉÑlÉÉ mÉÏÌQûiÉÇ qÉÉåÌWûiÉÇ cÉ qÉÔRûaÉpÉïÍqÉirÉÉWÒû: ||
(A.xÉÇ sha.4/29)
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Dr.Priya Sharma, PG 2nd Year
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5. • aÉëÉqrÉkÉqÉï rÉÉlÉuÉÉWûlÉ AkuÉaÉqÉlÉ mÉëxZÉsÉlÉ
mÉëmÉiÉlÉ mÉëmÉÏQûlÉ kÉÉuÉlÉ AÍpÉbÉÉiÉ
AÌiÉäÉMüOÒûÌiÉ£üpÉÉåeÉlÉ vÉÉÉåMüÉÌiɤÉÉUxÉåuÉlÉ
AiÉÏxÉÉUuÉqÉlÉÌuÉUåcÉlÉ mÉëåÇZÉÉåsÉlÉÉeÉÏhÉï
aÉpÉïÉÉiÉlÉ mÉëpÉ×ÌiÉÍpÉÌuÉï vÉåwÉæoÉïlkÉlÉÉlqÉÑcrÉiÉå aÉpÉï:
TüsÉÍqÉuÉ uÉ×liÉoÉlkÉlÉÉSÍpÉbÉÉiÉÌuÉvÉåwÉæ:||
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Dr.Priya Sharma, PG 2nd Year
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6. • xÉ ÌuÉqÉÑ£üoÉlkÉlÉÉå aÉpÉÉïvÉrÉqÉÌiÉ¢üqrÉ rÉM×üimsÉÏWûÉl§ÉÌuÉuÉUæUuÉxÉÇxÉë
xÉqÉÉlÉ: MüÉå¸xÉǤÉÉåpÉqÉÉmÉÉSrÉÌiÉ |iÉxrÉÉ eÉPûUxÉǤÉÉåpÉɲÉrÉÑUmÉÉlÉÉå
qÉÔRû: mÉɵÉïoÉÎxiÉvÉÏwÉÉåïSU rÉÉåÌlÉvÉÔsÉÉlÉÉWûqÉÔ§ÉxÉÇaÉÉlÉÉqÉlrÉiÉqÉqÉÉmÉɱ
aÉpÉïÇ urÉÉuÉrÉÌiÉ iÉÃhÉÇ vÉÉåÍhÉiÉxÉëÉuÉåhÉ ||
(xÉÑ.ÌlÉ.8/3)
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Dr.Priya Sharma, PG 2nd Year
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7. iÉiÉ: MüÐsÉ: mÉëÌiÉZÉÑUÉã oÉÏeÉMü: mÉËUbÉ CÌiÉ
• MüÐsÉ:
• iÉ§É EkuÉïoÉÉWÒûÍvÉU: mÉÉSÉã rÉÉã rÉÉãÌlÉqÉÑZÉÇ ÌlÉÃhÉÌ® MüÐsÉ CuÉ xÉ: MüÐsÉ: |
mÉëÌiÉZÉÑU:
ÌlÉ:xÉ×iÉ WûxiÉmÉÉSÍvÉU: MüÉrÉxÉÇaÉÏ mÉëÌiÉZÉÑU: |
oÉÏeÉMü:
rÉÉã ÌlÉaÉïcNûirÉãMüÍvÉUÉãpÉÑeÉ: xÉ oÉÏeÉMü: |
mÉËUbÉ:
rÉxiÉÑ mÉËUbÉ CuÉ rÉÉãÌlÉqÉÑZÉqÉÉuÉ×irÉ ÌiɸÌiÉ xÉ mÉËUbÉ
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Dr.Priya Sharma, PG 2nd Year
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8. iÉ§É EkuÉïoÉÉWÒûÍvÉU: mÉÉSÉã rÉÉã rÉÉãÌlÉqÉÑZÉÇ ÌlÉÃhÉÌ® MüÐsÉ CuÉ xÉ: MüÐsÉ
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9. rÉÉã ÌlÉaÉïcNûirÉãMüÍvÉUÉãpÉÑeÉ: xÉ oÉÏeÉMü:
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Dr.Priya Sharma, PG 2nd Year
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10. 02-02-2014
Dr.Priya Sharma, PG 2nd Year
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11. rÉxiÉÑ mÉËUbÉ CuÉ rÉÉãÌlÉqÉÑZÉqÉÉuÉ×irÉ ÌiɸÌiÉ xÉ mÉËUbÉ
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Dr.Priya Sharma, PG 2nd Year
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12. 1.
Dwaram nirudhya shirsa
OVER ENLARGEMENT OF FETAL
HEAD
2.
Jatharen kaschit
ABDOMEN PRESENTATION Or
TRANSVERSE LIE OR CORD
PRESENTATION
3.
Shareera parivartit kubja deha
Body rotated and presenting with hump
back.
4.
Eka bhuja
Hand prolapse in transverse lie or in
vertex presentation
5.
Bhuja dwayena
Presenting with both hands
6.
Tiryaka gata
Transverse lie without flexion of fetal
body
7.
Kaschit aangmukho anyah
Face presentation
8.
Parshavapvrit gati
12
Presentation with flanks or lateral delivery

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Dr.Priya Sharma, PG 2nd Year
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14. aÉpÉïMüÉãwÉÉmÉUÉxÉÇaÉÉã qÉYMüsÉÉã rÉÉãÌlÉxÉÇuÉ×ÌiÉ: |
WûlirÉÉiÉç x§ÉÏrÉÇ qÉÔRûaÉpÉãï rÉjÉÉã£üɶÉÉmrÉÑmÉSìuÉÉ: | (xÉÑ.xÉÔ.33/13)
iÉ§É ²ÉuÉlirÉÉuÉxÉÉkrÉÉæ qÉÔRûaÉpÉÉæï |
vÉãwÉÉlÉÉÌmÉ ÌuÉmÉUÏiÉãÎlSìrÉÉjÉÉï¤ÉãmÉMü: (uÉÉiÉ ÌuÉMüÉU-mÉÉS ÌOûMüÉ)
rÉÉãÌlÉpÉëÇvÉxÉÇuÉUhÉ qÉYMüssɵÉÉxÉMüÉxÉpÉëqÉÌlÉÌmÉÌQûiÉÉlÉç mÉËUWûUãiÉç || 6
mÉëÌuÉkrÉÌiÉ ÍvÉUÉã rÉÉ iÉÑ vÉÏiÉÉÇaÉÏ ÌlÉUmɧÉmÉÉ |
lÉÏsÉÉã®iÉÍxÉUÉ WûÎliÉ xÉÉ aÉpÉïÇ xÉ cÉ iÉÉÇ iÉjÉÉ ||xÉÑ0 ÌlÉ0 8/6,11
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15. • अऩववधशिरभ यभ तु िीतभंगी ननऩािऩभ
ननऱोदतशसरभ हस्त्न्त सभ गर्ाम ् स च तभं तथभ l
• Madhukosha- अऩववधशिरभ शिरो
धभरनयतुमिक्तेत्यथा्, अवनतशिरभ इनत गदभधर्
………नीऱोद्गतशसरभ इनत नीऱवणभा उद्गतभ शसरभ
कऺौ यरयभ् सभ l
ु
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16. • Madhava nidanam- योननसमवरणम ् सन्ग् कऺौ
ु
मकल्ऱ एव च ll
हन्य् स्त्रियं मड्.गर्भा यथोक्तश्चभप्यऩद्रवभ्
ु
ू
ु
मधकोश- संग् कक्षाविति योतनसंिरणे प्रतितनव्रत्िौ
ु
ू
ु
िायगर्भश्यं यदा तनरुणधध िदा गर्भ् कक्षौ सक्िो र्िति स
ु
ु
उच्यिे- संग् कक्षाविति
ु
M.N64/7-madhukosha
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17. 02-02-2014
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18. 1.vata prakopaka ahara vihara ati sevana by
garbhini stri
2.ati maithuna
3.ati jagarana
prakopa of
yoni marga
gata and
garbhashy
astha vayu
death of
garbhini
02-02-2014
closes
yoni
marga
dwara
sva avrodha
of vayu-
YONISAM
VARANA
Excessive pressure of
vata in garbhashya and
yoni patha(birth canal)
as well as association
garbha
between garbha’s nabhi
mrityu
nadi and garbhini’sSharma, PG 2nd Year
Dr.Priya
hridaya nadi
avrodha of
garbhashya
dwara
ati
peeda
na of
garbh
a by
this
vayu
nirudha shwasa of
garbha
18

19. •
Yoni Samvaranam
•
Closure of GARBHASHYA MUKHA
•
गर्ा् कऺौ सक्तो र्वनत
ु
02-02-2014
गर्ा संग
Dr.Priya Sharma, PG 2nd Year
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20. • वभयु् प्रकवऩत् कयभात ् संरुध्य रुधधरं स्रुतम ्
ु
ु
• सतभयभ हृस्त्त्िरोबस्त्रतमऱम ् मक्कऱसंगयकम ् ll
ू
ू
• मक्कऱो रक्तमभरुतज् िऱ वविेष् Madhukosha tika
ू
Although sushruta has considered shoola in prasoota
stri as makkala, but here, prasava poorva shoola or
pain before labour pain is also taken as MAKKALA
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21. •
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22. Garbhakosha Parasanga
Rupture Uterus
Yoni Samvaranam
Cervical Dystocia
Makkala
Intrapartum haemorrhage with severe pain
OR tetanic or spasmodic or irregular
uterine contractions(tetany of uterus)
Yoni Bhramsha
Uterine prolapse
Yoni Sanga/sankocha
Obstruction of fetus in maternal passage
due to contraction of pelvis.
Sheetangta
Improper functioning of circulatory system
Neelodhita sira
Indicative of loss of physical power
Nirpatrapa or lajjaheenata
Indicative of loss of psychological power
22

23. Akshepaka
Due to toxemia
Kasa , shwasa, bhrama
Due to weakness or HTN
Pooti udgara
Due to ketone bodies formation
Mukashto -harita
Slow progress –prolonged labour
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24. • Last two Gatis of Mudhagarbha are Asadhya i.e. –
• Hasta-pada-shirodaya (obstructed labour due to
faulty presentation)
• One foot in yoni & other in anus(remote effects of
undiagnosed obstructed labour)
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25. Modern comparision of Asadhya
Mudha Garbha lakshanasOBSTRUCTED LABOUR
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26. • Defined as the one in which inspite of good uterine
contractions, the progressive descent of presenting part
is arrested due to mechanical obstruction.
• Incidence – 1-2% in developing countries
• Causes• Fault in Passage
• Fault in Passenger
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27. • 1.BONY OBSTRUCTIONS
• 2.SOFT TISSUE OBSTRUCTIONS
• BONY-1.CONTRACTED PELVIS AND CPD are main
causes
• 2.SOFT TISSUE OBSTRUCTIONS- includes cervical
dystocia, cervical or broad ligament fibroid, impacted
ovarian tumour or non graavid horn of bicornuate uterus
below the presenting part.
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28. • Transverse lie
• Brow presentation
• Congenital malformation of foetus- hydrocephalus, fetal
ascitis
• Big Baby- occipito posterior position
• Compound presentation
• Locked twins
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29. 02-02-2014
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30. •
•
•
•
•
•
•
Caused by a tear in the wall of the uterus, when
the uterus can’t stand the pressure exerted on it.
Predisposing FactorsVertical scar
Multiple Gestation
Prolonged labor
Obstructed labor
Faulty presentation
Traumatic Maneuvers
Faulty use of oxytocin
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31. • 1. Complete — direct communication
between the uterine and peritoneal cavities.
• 2. Incomplete — rupture into the peritoneum,
covering the uterus or into broad ligament
but not in the peritoneal cavity
• 3. Dehiscence — a partial separation of an old
Scar.
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32. – Abdominal pain and tenderness
– Chest pain between the scapula or on inspiration
– Hypovolemic shock caused by hemorrhage
– Signs associated with impaired fetal oxygenation
– Absent fetal heart tones , cessation of uterine
contractions
– Palpation of fetus outside the uterus
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33. 02-02-2014
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34. • Resucitation
• Hysterectomy -subtotal
• Repair
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laprotomy
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35. • Cervical dystocia: Difficult labor and delivery caused by
mechanical obstruction at the cervix.
• Dystocia comes from the Greek "dys" meaning "difficult,
painful, disordered, abnormal" + "tokos" meaning "birth."
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36. • Cervical dystocia is nothing but a complication arising
during labor that causes difficulty in delivery because the
cervix is obstructed.
• This abnormal condition of labor is a result of the
ineffectual dilation of the cervix ,though quite a rare
condition, it can lead to serious difficulties to the
mother and the baby.
• A cervical dystocia basically happens at the external os.
The complete cervical canal is consumed, and then often
thinned out. The external os however, remains
incompletely dilated or even closed at times.
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37. • 1.Inefficient Uterine Contractions
• 2.Malpresentation, malposition
• 3.Spasm of cervix
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38. • Primary
• Secondary
• PRIMARY- commonly observed during the first birth
where the external os fails to dilate.
• Uterine contractions are often ineffective
• Edema of cervix also might occur and delivery may be
accomplished with version of anterior lip.
• SECONDARY Cervical Dystocia- results usually due to
excess scarring or rigidity of cervix from effect of previous
operation or disease.
• Treatment- delivery by cessarian section preferred
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39. • Pronounced retraction occurs involving whole of uterus
upto level of internal os.
• So, the physiological differentiation between active upper
segment and passive lower uterine segment of uterus is
lost.
• No thinnig of lower segment of uterus occurs.
• The uterine contraction ceases and the whole uterus
undergoes a sort of tonic muscular spasm holding the
foetus inside.
• Treatment- cs section preferred
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40. • Failure to overcome obstruction by powerful contractions
of uterus
• Injudicious use of oxytocics
• CLINICAL FEATURES• Severe continuous pain
• Uterus appears smaller in size , tense and tender on
examination.
• FHS is not audible
• Vaginal examination reveals jammed head with big caput
as well as dry and oedematous vagina.
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41. • There is marked hypertrophy and oedema of cervix and
first degree becomes second degree, cystocele and
rectocele become pronounced and there is aggravation
of stress incontinence.
• Vaginal discharge may be copious and decubitus ulcer
may develop when the cervix remains outside the
interoitus.
• Incarceration might occur if uterus fails to rise above the
pelvis by 16th weak of pregnancy.
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42. •
•
•
•
•
•
•
•
There are increased chances of1. abortion
2.PROM
3.Intrauterine infection
EFFECTS ON LABOUREarly Rupture of membranes
Cervical dystocia
Prolonged labour due to non dilatation of cervix and
obstruction due to sagging cystocele aand rectocele
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43. • Bed rest complete
• Intravaginal plugging soaked with glycerine and
acriflavine
• Prophylactic antibiotics
• Manual stretching of cervix or pushing up of cystocele or
rectocele
• Duhrssen’s incision at 2 and 10 O’ clock positions
followed by ventouse or forceps extraction
• Cessarian section – if cx.is undilated, thick or edematous
and/ or head is high up.
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44. • Alteration in size and /or shape of pelvis of sufficient
degree so as to alter the normal mechanism of labour in
an average size baby.
• Causes• Nutritional and environmental defects
• Diseases or injuries affecting bones of pelvis like
fractures, tumours, kyphosis of spine, scoliosis,
coccygeal deformities etc.
• Developmenatl defects- robert’s pelvis, Naegele’s pelvis
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45. •
•
•
•
Increased incidence of EROM
Increased chances of cord prolapse
Cervical dilatation slowed
Increased tendency of prolonged labour and obstructed
labour with features like exhausation, dehydration, keto
acidosis and sepsis
• Increased incidence of operative interfarence, shock ,
PPH and sepsis.
• Increased maternal morbidity and mortality
• Increased fetal mortality and morbidity
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46. • Cessarian section
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47. • Maternal• Immediate- exhaustion
•
•
•
•
•
Neelodhita sira
Dehydration- (Sheetangata)
Metabolic acidosis- (pooti udgara)
Genital sepsis
Injury to genital tract
PPH and shock
• Death occurs due to rupture uterus and sepsis with
metabloic changes
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48. If patient survives-genito urinary fistula or recto vaginal
fistula
• Variable degree of vaginal atresia
• Secondary amenorrhoea following hysterectomy due to
rupture or Sheehan’s syndrome.
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49. •
•
•
•
•
Asphyxia
Acidosis
Intracranial haemorrhage
Infection
All these lead to increased perinatal loss.
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50. •
•
•
•
PrinciplesRelieve obstruction at earliest
Combat dehydration and keto acidosis
To control sepsis
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51. • ²ÉuÉlirÉÉuÉç AxÉÉkrÉÉæ qÉÔRûaÉpÉÉæï |
LãuÉqÉvÉYrÉã vÉx§ÉqÉuÉcÉÉUrÉãiÉç || (xÉÑ.ÍcÉ.15/9)
Shalya Chikitsa-steps• 1.NBM-मढगर्ोदरभिोऽश्मरीर्गन्दरमुखरोगेष्वर्ुक्तवत्कमा
ू
कवॉत- sushruta su.5/16
ु
• 2.CONSENT Be Taken-
• iÉxqÉÉSÍkÉmÉÌiÉqÉÉmÉëÑcdrÉ mÉUÇcÉ rɦÉqÉÉxjÉÉrÉÉãmÉ¢üqÉãiÉ |
(xÉÑ.ÍcÉ.15/3)
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52. • मते चोत्िानाया आर्ग्नसक््या वरिभधभरकोन्नशमतकट्यभ
ु
ृ
धन्वननगवस्त्त्तकभिभल्मऱीमत्रनघतभभयभं म्रऺनयत्वभ हरतं योनौ
ृ
ृ
ृ
प्रवेश्यगर्ामऩहरे त ् | su chi-15/9
ु
• Destructive surgeries are to be done in case of ASADHYA MUDHA
GARBHA
• General principles-
• यद्यदङ्गंहह गर्ारय तरय सज्जनत तनिषक् सम्यस्त्ववननहारेस्त्छित्त्वभ
रऺेन्नभरीं च यत्नत्l
• गर्ारय गतयस्त्श्चिभ जभयन्तेऽननऱकोऩत्तिभनल्ऩमनतवैद्यो वतेत
ववधधऩवकमll su.chi15/13,14
्
ू ा
•
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Dr.Priya Sharma, PG 2nd Year
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53. • तत् स्त्रियमभश्वभरय मण्डऱभग्रेणभङ्गऱीिरिेण वभ शिरो ववदभया,
ु
• शिर्कऩभऱभन्यभहृत्य, िङ्कनभ गहीत्वोरशस कऺभयभं वभऽऩहरे त ्;
ु
ृ
अशर्न्नशिरसमक्षऺकटे गण्डे वभ, अंससंसक्तरयभंसदे िे बभहू
ू
नित्त्वभ, दृनतशमवभततं वभतऩणोदरं वभ ववदभया ननररयभन्िभणण
ू
शिधथऱीर्ूतमभहरे त ्, जघनसक्तरय वभ जघनकऩभऱभनीनत su.ch15/12
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54. • Indications :
• Maternal death in Mudhagarbha Avastha to save the fetus.
• Pre-requisites :
• Fetus has attained full maturity --eÉlqÉMüÉsÉã lÉuÉqÉqÉÉxÉÉÌSMüÉsÉã | (Qû)}
• Maximum Time of Udarapatana :
• Upto 2 ghatis i.e.; 48 mins.
• Site of Incision : Bastidwara
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Dr.Priya Sharma, PG 2nd Year
54

55. •
•
•
•
•
•
•
Apara Patana
Abhyanga
Yoni Sneha, pichu
Vataghna Yogas for 10 days
Sneha pana for 3, 5 or 7 days (depending on Prakruti)
Asava or Arishta pana at night
Pathya-for 4 months
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Dr.Priya Sharma, PG 2nd Year
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56. •Thank You
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Dr.Priya Sharma, PG 2nd Year
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57. Jarayu-patana + Samshamana chi.
Mantra chikitsa
Shalya karma
Jarayu Patana- using langli, dhuma, basti, local
applications
Mantra chikitsaChyavana mantra
Maatangi vidya
Other mantras mentioned in context of vilambita prasava
02-02-2014
Dr.Priya Sharma, PG 2nd Year
57

58. 02-02-2014
Dr.Priya Sharma, PG 2nd Year
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