yoni samavaranam

02-02-2014 Dr.Priya Sharma, PG 2nd Year 1

Dr.Priya Sharma

PG Scholar

Deptt.Of P.G Studies In P.T.S.R

Batch -2010

• योननसमवरणम ्सन्ग् कुऺौ मकल्ऱ एव चहन्यु् स्त्रियं मडू्.गर्भा यथोक्तश्चभप्यऩुद्रवभ्(M.N

64/10)

• In this verse, Madhavakara talks about

ASADHYA MOODA GARBHA

LAKSHANAS.

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

• qÉÔRû: MüUÉãÌiÉ mÉuÉlÉ: ZÉsÉÑ qÉÔRû aÉpÉïqÉç|| (qÉÉ0 ÌlÉ0, pÉÉ0

mÉë0, rÉÉã0 U0)

• qÉÔRûÉã urÉÉxÉ£ü aÉÌiÉ: | qÉkÉÑMüÉãvÉ urÉZrÉÉ

02-02-2014 Dr.Priya Sharma, PG 2nd Year 3

• 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)

02-02-2014 Dr.Priya Sharma, PG 2nd Year 4

• aÉëÉqrÉkÉqÉï rÉÉlÉuÉÉWûlÉ AkuÉaÉqÉlÉ mÉëxZÉsÉlÉ

mÉëmÉiÉlÉ mÉëmÉÏQûlÉ kÉÉuÉlÉ AÍpÉbÉÉiÉ

AÌiÉäÉMüOÒûÌiÉ£üpÉÉåeÉlÉ vÉÉÉåMüÉÌiɤÉÉUxÉåuÉlÉ

AiÉÏxÉÉUuÉqÉlÉÌuÉUåcÉlÉ mÉëåÇZÉÉåsÉlÉÉeÉÏhÉï

aÉpÉïÉÉiÉlÉ mÉëpÉ×ÌiÉÍpÉÌuÉï vÉåwÉæoÉïlkÉlÉÉlqÉÑcrÉiÉå aÉpÉï:

TüsÉÍqÉuÉ uÉ×liÉoÉlkÉlÉÉSÍpÉbÉÉiÉÌuÉvÉåwÉæ:||

02-02-2014 Dr.Priya Sharma, PG 2nd Year 5

• 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)

02-02-2014 Dr.Priya Sharma, PG 2nd Year 6

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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 7

iÉ§É EkuÉïoÉÉWÒûÍvÉU: mÉÉSÉã rÉÉã rÉÉãÌlÉqÉÑZÉÇ ÌlÉÃhÉÌ® MüÐsÉ CuÉ xÉ: MüÐsÉ

02-02-2014 Dr.Priya Sharma, PG 2nd Year 8

rÉÉã ÌlÉaÉïcNûirÉãMüÍvÉUÉãpÉÑeÉ: xÉ oÉÏeÉMü:

02-02-2014 Dr.Priya Sharma, PG 2nd Year 9

02-02-2014 Dr.Priya Sharma, PG 2nd Year 10

rÉxiÉÑ mÉËUbÉ CuÉ rÉÉãÌlÉqÉÑZÉqÉÉuÉ×irÉ ÌiɸÌiÉ xÉ mÉËUbÉ

02-02-2014 Dr.Priya Sharma, PG 2nd Year 11

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 Presentation with flanks or lateral delivery

in transverse lie

12

02-02-2014 Dr.Priya Sharma, PG 2nd Year 13

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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 14

• अऩववधशिरभ यभ तु िीतभंगी ननऩािऩभननऱोदतशसरभ हस्त्न्त सभ गर्ाम ्स च तभं तथभ l

• Madhukosha- अऩववधशिरभ शिरोधभरनयतुमिक्तेत्यथा् , अवनतशिरभ इनत गदभधर्………नीऱोद्गतशसरभ इनत नीऱवणभा उद्गतभ शसरभकुऺौ यरयभ् सभ l

02-02-2014 Dr.Priya Sharma, PG 2nd Year 15

• Madhava nidanam- योननसमवरणम ्सन्ग् कुऺौमकल्ऱ एव च ll

हन्यु् स्त्रियं मडू्.गर्भा यथोक्तश्चभप्यऩुद्रवभ्

मधकुोश- संग् कुक्षाविति योतनसंिरणे प्रतितनव्रतू्िौिायगुर्भश्यं यदा तनरुणधध िदा गर्भ् कुक्षौ सक्िो र्िति सउच्यिे- संग् कुक्षावितिM.N64/7-madhukosha

02-02-2014 Dr.Priya Sharma, PG 2nd Year 16

02-02-2014 Dr.Priya Sharma, PG 2nd Year 17

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

closes

yoni

marga

dwara

sva avrodha

of vayu-

avrodha of

garbhashya

dwara

ati

peeda

na of

garbh

a by

this

vayu

nirudha shwasa of

garbhagarbha

mrityu

Excessive pressure of

vata in garbhashya and

yoni patha(birth canal)

as well as association

between garbha’s nabhi

nadi and garbhini’s

hridaya nadi

death of

garbhini

YONISAM

VARANA

• Yoni Samvaranam

• Closure of GARBHASHYA MUKHA

• गर्ा् कुऺौ सक्तो र्वनत गर्ा संग

02-02-2014 Dr.Priya Sharma, PG 2nd Year 19

• वभयु् प्रकुवऩत् कुयभात ्संरुध्य रुधधरं सु्रतम ्• सूतभयभ हृस्त्त्िरोबस्त्रतमूऱम ्मक्कऱसंगयकम ् ll

• मक्कऱो रक्तमभरुतज् िूऱ वविषे् 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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 20

•

02-02-2014 Dr.Priya Sharma, PG 2nd Year 21

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 power22

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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 23

• 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)

02-02-2014 Dr.Priya Sharma, PG 2nd Year 24

Modern comparision of AsadhyaMudha Garbha lakshanas-OBSTRUCTED LABOUR

02-02-2014 Dr.Priya Sharma, PG 2nd Year 25

• 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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 26

• 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.

02-02-2014 Dr.Priya Sharma, PG 2nd Year 27

• Transverse lie

• Brow presentation

• Congenital malformation of foetus- hydrocephalus, fetal

ascitis

• Big Baby- occipito posterior position

• Compound presentation

• Locked twins

02-02-2014 Dr.Priya Sharma, PG 2nd Year 28

02-02-2014 Dr.Priya Sharma, PG 2nd Year 29

Caused by a tear in the wall of the uterus, when

the uterus can’t stand the pressure exerted on it.

Predisposing Factors-

• Vertical scar

• Multiple Gestation

• Prolonged labor

• Obstructed labor

• Faulty presentation

• Traumatic Maneuvers

• Faulty use of oxytocin

02-02-2014 Dr.Priya Sharma, PG 2nd Year 30

• 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.

02-02-2014 Dr.Priya Sharma, PG 2nd Year 31

– 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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 32

02-02-2014 Dr.Priya Sharma, PG 2nd Year 33

• Resucitation laprotomy

• Hysterectomy -subtotal

• Repair

02-02-2014 Dr.Priya Sharma, PG 2nd Year 34

• 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."

02-02-2014 Dr.Priya Sharma, PG 2nd Year 35

• 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.

02-02-2014 Dr.Priya Sharma, PG 2nd Year 36

• 1.Inefficient Uterine Contractions

• 2.Malpresentation, malposition

• 3.Spasm of cervix

02-02-2014 Dr.Priya Sharma, PG 2nd Year 37

• 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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 38

• 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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 39

• 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.

02-02-2014 Dr.Priya Sharma, PG 2nd Year 40

• 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.

02-02-2014 Dr.Priya Sharma, PG 2nd Year 41

• There are increased chances of-

• 1. abortion

• 2.PROM

• 3.Intrauterine infection

• EFFECTS ON LABOUR-

• Early Rupture of membranes

• Cervical dystocia

• Prolonged labour due to non dilatation of cervix and

obstruction due to sagging cystocele aand rectocele

02-02-2014 Dr.Priya Sharma, PG 2nd Year 42

• 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.

02-02-2014 Dr.Priya Sharma, PG 2nd Year 43

• 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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 44

• 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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 45

• Cessarian section

02-02-2014 Dr.Priya Sharma, PG 2nd Year 46

• 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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 47

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.

02-02-2014 Dr.Priya Sharma, PG 2nd Year 48

• Asphyxia

• Acidosis

• Intracranial haemorrhage

• Infection

• All these lead to increased perinatal loss.

02-02-2014 Dr.Priya Sharma, PG 2nd Year 49

• Principles-

• Relieve obstruction at earliest

• Combat dehydration and keto acidosis

• To control sepsis

02-02-2014 Dr.Priya Sharma, PG 2nd Year 50

• ²ÉuÉlirÉÉuÉç AxÉÉkrÉÉæ qÉÔRûaÉpÉÉæï |

LãuÉqÉvÉYrÉã vÉx§ÉqÉuÉcÉÉUrÉãiÉç || (xÉÑ.ÍcÉ.15/9)

Shalya Chikitsa-steps-

• 1.NBM-मूढगर्ोदरभिोऽश्मरीर्गन्दरमुखरोगेष्वरु्क्तवत्कमाकुवॉत- sushruta su.5/16

• 2.CONSENT Be Taken-

• iÉxqÉÉSÍkÉmÉÌiÉqÉÉmÉëÑcdrÉ mÉUÇcÉ rɦÉqÉÉxjÉÉrÉÉãmÉ¢üqÉãiÉ |

(xÉÑ.ÍcÉ.15/3)

02-02-2014 Dr.Priya Sharma, PG 2nd Year 51

• मतृे चोत्िानाया आर्गु्नसक््या वरिभधभरकोन्नशमतकट्यभ धन्वननगवसृ्त्त्तकभिभल्मऱीमतृ्रनघतृभभयभं म्रऺनयत्वभ हरतं योनौ प्रवेश्यगर्ामुऩहरेत ्| su chi-15/9

• Destructive surgeries are to be done in case of ASADHYA MUDHA

GARBHA

• General principles-

• यद्यदङ्गंहह गर्ारय तरय सज्जनत तनिषक् सम्यस्त्ववननहारेस्त्छित्त्वभरऺेन्नभरीं च यत्नत्l

• गर्ारय गतयस्त्श्चिभ जभयन्तेऽननऱकोऩत्तिभनल्ऩमनतवदै्यो वतेतववधधऩवूाकमl्l su.chi15/13,14

•

02-02-2014 Dr.Priya Sharma, PG 2nd Year 52

• तत् स्त्रियमभश्वभरय मण्डऱभगे्रणभङ्गुऱीिरिणे वभ शिरो ववदभया,• शिर्कऩभऱभन्यभहृत्य, िङ्कुनभ गहृीत्वोरशस कऺभयभं वभऽऩहरेत;् अशर्न्नशिरसमक्षऺकूटे गण्ड ेवभ, असंसंसक्तरयभंसदेि ेबभहू नित्त्वभ, दृनतशमवभततं वभतऩूणोदरं वभ ववदभया ननररयभन्िभणण शिधथऱीर्ूतमभहरेत,् जघनसक्तरय वभ जघनकऩभऱभनीनत su.ch-

15/12

02-02-2014 Dr.Priya Sharma, PG 2nd Year 53

• 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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 54

• 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

02-02-2014 Dr.Priya Sharma, PG 2nd Year 55

02-02-2014 Dr.Priya Sharma, PG 2nd Year 56

•Thank You

Jarayu-patana + Samshamana chi.

Mantra chikitsa

Shalya karma

Jarayu Patana- using langli, dhuma, basti, localapplications

Mantra chikitsa-

Chyavana mantra

Maatangi vidya

Other mantras mentioned in context of vilambita prasava

02-02-2014 Dr.Priya Sharma, PG 2nd Year 57

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