ayurvedic management of premature uterine...

AAMJ / Vol. 4 / Issue 1 / Jan – Feb 2018

A A M J Anveshana Ayurveda Medical Journal

www.aamj.in ISSN: 2395-4159

Case Report

Ayurvedic Management of Premature Uterine Contraction

Alka*

A b s t r a c t

Premature uterine contraction is the main symptom of premature labour with occurrence of no

regular uterine contractions (4 or more in 20 minutes or 8 or more in 1 hr) and cervical changes

(effacement equal to or greater than 80% and dilation equal to or greater than 1 cm) in women

with intact fetal membranes and gestational age less than 37 weeks. 15 million babies are born

preterm, every year according to WHO statistics and this number is rising. Tocolytic agents

used to suppress premature contractions and prevent preterm labour, are not proven to be effi-

cacious in preventing preterm birth or reducing neonatal mortality or morbidity. In Ayurvedic

classics, Akāla Prasava is mentioned which can be correlated to preterm labour. Expulsion of

foetus is the function of Apāna Vāta and Vaigunya of Apāna Vāta (Prasuti Māruta) causes

Akāla Prasava. Basti is considered the best for managing the deranged Apāna Vāta. Basti is

also indicated in Garbhini Paricharya (routine antenatal care) after completion of seven

months. In this present case study, Śatāvaryādi Kṣīrapāka Basti was administered in a 21-year-

old primi gravida patient of 32 weeks’ pregnancy with premature contractions, wherein isox-

suprine hydrochloride proved to be ineffective. Basti with 450 ml Śatāvaryādi Kṣīrapāka ad-

ministered per rectal for 2 consecutive days was found to be effective in preventing the uterine

contractions.

Keywords: Preterm labour, Akāla Prasava, isoxsuprine hydrochloride, tocolytic agents.

*Lecturer, Department of Prasooti Tantra and Stree Roga, LBS Mahila Ayurvedic College, Yamunana-

gar, Haryana, India.

CORRESPONDING AUTHOR

Dr. Alka Lecturer,

Department of Prasooti Tantra and Stree Roga,

LBS Mahila Ayurvedic College,

Yamunanagar, Haryana, (India).

Email: [email protected]

http://aamj.in/wp-content/uploads/Volume4/Issue1/AAMJ_1672_1675.pdf

Alka: Ayurvedic Management of Premature Uterine Contraction

AAMJ / Vol. 4 / Issue 1 / Jan– Feb 2018 1673

INTRODUCTION

reterm labour (PTL) is defined as one where the labor

starts before the 37th completed week (< 259 days)

whereas in developed countries it has been brought

down to 20 weeks, in developing countries it is 28 weeks.

Preterm birth is the significant cause of perinatal morbidity

and mortality.[i] 5-10% of all pregnancies ends in preterm

labour. In about 50% the cause is not known. Causes may be

stress, coitus- prostglandins released during coitus leads to

premature uterine contractions, in unwanted pregnancy due

to lack of antenatal care, poor nutrition, past history of

preterm labour is a risk factor for premature contraction,

smoking or chewing tobacco during pregnancy, multiple

gestation, polyhydrominos, IUD, placental infarction,

placenta praevia. Infections like UTI etc. Management –bed

rest, adequate oxygenation, micronised progesterone to

inhibit uterine contraction, antibiotics, sedation(pethidine 50

to 100 mg i/m) and hydration (500ml ringer lactate or 5%

dextrose –normal saline), tocolytic agents (isoxsuprine 5-

20mg every 6 hour).[ii] In Ayurvedic texts, the acharyas has

mentioned about some conditions which can be correlated

with preterm labour. Charaka clearly mentions that the

normalcy of Śukra, Ārtava, Ātmakarma, Āśaya, Kāla and diet

along with mode of life of mother is essential for the full term

delivery of matured foetus. Any abnormality in any of these

factors may cause Akālaprasava.[iii] Charaka also mentioned

that abnormalities of factors responsible for normal

development of foetus causes Achirajāta. Achira (early), jāta

(born) can be considered as premature labour. According to

Madhukosa commentary of Madhava Nidana preterm labour

can be correlated with Viprasava[iv] and Akālaprasava

according to Arunadatta commentary.[v] Harita has referred

that delivery can take place before completing full term due

to the abnormalities of doshas specially propelled by Vāyu.[vi]

In Ayurveda classics for treatment of Prasramsamana

Garbha associated with Pārśva Pṟuṣṭa Śūla and Prachalita

Garbha, Kṣīrapāka Kwātha is mentioned.[vii]

Case Report

A primigravida pt. of 21 yr age came to the LBS Mahila

Ayurvedic hospital on 29/11/2017 with complaint of pain in

abdomen on & off since the time she got pregnant. She was

having pregnancy of 7 months & 3 days. OPD/IPD

no.4254/398. She was a primi gravida with LMP on

26/04/2017 & EDD on 02/02/2018. Past menstrual history-

regular. Marital history-3yrs. Treatment history-taking tab.

Tidilian (20 mg) 1 bd. Per abdomen examination revealed

longitudinal lie with cephalic presentation and fundal height

corresponding to weeks of pregnancy. Foetal head was

floating. Mild uterine contractions lasting for 15 to 20

seconds in every 30 minutes associated with severe pain.

Foetal heart rate was found to be 142 bpm. Pt. was admitted

in hospital on 30/11/2017. Complete bed rest with head low

position was advised. Isoxsuprine hydrochloride injection 5

mg in 500 ml RL at the rate of 12-15 drops/ min. was given.

Treatment given was a combination of Arjuna, Bala,

Shatavari, Guduchi, Bramhi 1gm each bd orally with milk &

Saptamrita lauha-500mg, Amalki churna-3gm, Sankha

bhasma-500mg bd with ghrita for 7 days. During this

treatment abdominal pain was absent. But on 7/01/2018 she

again complaints of severe abdominal pain with contractions.

So Tab. Tidilan Retard 40 mg was given orally twice daily

after food but it didn’t improve the condition of the patient to

the satisfactory level. So Śatāvaryādi kṣīra basti was

given(from 16-25 dec) for 10 days. During this 10 days

treatment& after treatment she didn’t feel any pain in

abdomen. Usg report on 11/12/2017 –vertical lie,

presentation cephalic, 32 weeks foetus, cardiac activity

present, foetal movements- present, Placenta- Rt. Fundal

grade 2, foetal weight-1.9 kg, amniotic fluid-mildly reduced.

Patients continued the pregnancy till term and delivered a

healthy full term male baby (2.5 kg) on 22/01/2018 (POG –

38 weeks 3 days).

Table No. 1. Investigations

Hb BG 11.3gm/dl, B+ve.

TLC 11200/ cumm

DLC N,L,E,M- 80%,17%,01%,02%

ESR 48mm/hr

Sr. cholesterol 210mg/dl

Sr. triglycerides 231mg/dl

FBS 68mg/dl

LFT SGPT-21 IU/L,SGOT-18 IU/L,

Bilirubin 0.6 mg/dl.

RFT Blood urea-19 mg/dl,

S.creatinine-1.0 mg/dl.

Urine routine,

microscopic

Pus cells-20-25 /HPF

HIV/HbsAg/VDRL Negative

Table No. 2. General examination

B.P. 120/70mm of Hg

P/R 76/min

R/R 16/min

Temp. 98.40 F

Built Obese

Pallor, oedema Absent

Height 150cm

Weight 69kg

Table No. 3: Drug review[viii]

Drug

name Latin name Rasa Guna Vīrya Vipāka

Shatavari

Asparagus

racemosus(Willd.

)

Madhu

ra,

Tikta

Guru,

Snigdha Śīta

Madhur

a

Godugdha Cow milk(eng) Madhu

ra

Guru,

Snigdha Śīta

Madhur

a

Arjuna

Terminalia

arjuna (Roxb.ex

DC.) Wight &

Arn.

Kasha

ya

Laghu,

Ruksha Śīta Katu

Bala Sida cordifolia L. Madhu

ra

Laghu,

Snigdha

,

picchila

Śīta Madhur

a

P



Table No.4. Ingredients of Śatāvaryādi kṣīra Basti

Name of

drug

Part

used

Quan

tity

Dosha

Karma Pradhana Karma

Shatavari Root

1

part(1

0gm)

Vatta

pitta

shamaka

Medhya,Śukrala,G

arbhaposhaka,Sta

nyajannana,Balya,

Rāśayana

Arjuna

Stem

bark

1

part(1

0gm)

Kapha

pitta

shamaka

Hridya, Balya

Bala

Whol

e

plant

1

part(1

0gm)

Vatta

pitta

shamaka

Balya,Śukrala,Pra

jasthapāna,ojovar

dhaka,

Garbhaposhaka

Godugdh

a -

15

parts(

450ml

)

Vatta

pitta

shamaka

Jeevanya,

Rāśayana

Table No. 5. Treatment Protocol

Procedure Basti

Drug Śatāvaryādi kṣīra jala

Form Kṣīrapāka

Dose 450 ml

Duration 10 days

Route Gudamarg

Method Catheter

Time Morning [9am].

Method of preparation of Kṣīrapāka[ix]

Shatavari, Bala, Arjuna in powdered form(fine power) taken

in equal quantity i.e.10gm each (total 30 gm), Kṣīra 15 parts

(450 ml) and water 15 parts (450 ml) boiled on Mandagni

until only milk remains. The Kṣīrapāka obtained is filtered

and used for Basti.

Procedure of Basti: Firstly the patient should be lie down in

left lateral position then freshly prepared luke warm

Śatāvaryādi Kṣīrapāka Basti is administered. Rubber

catheter No.8 attached with enema cane was used for

administration of Basti. Tip of the catheter and anal orifice

were lubricated with the oil & air was removed. Then the tip

of catheter inserted into anal canal of the patient slowly until

it reaches up to 3-4 inches. After that, Basti was administered

very slowly and the patient was asked to take deep breath.

After administration the patient was asked to turn into supine

position and rest on the table till she feels the urge for

defecation. Basti Nirgamana Kāla was 15 to 30 minutes.

DISCUSSION

Though isoxsuprine suppresses the premature uterine

contractions to some extent, but it exhibit some side effects

like hypotension, tachycardia, cardiac failure, ARDS,

hyperglycemia, pulmonary oedema or even death. Although

delivery may be delayed long enough for administration of

corticosteroids, but perinatal outcome does not improved by

this treatment. Due to the life threatening side effects of

modern drugs (isoxsuprine ) there is a need for safe, effective

and alternative treatment to suppress the preterm

contractions. Shatavari produced a state of reduced

adrenocortical activity in adrenal weight and plasma cortisol

in experimental animals. Shatavari(Asparagus racemosus) is

known to produce anti oxytocic effect. Bala and Shatavari

possess Rāśayana, Garbhaposhaka, Balya, properties which

maintains and supports the pregnancy. Due to Vāta Shamaka

property of Bala, vitiated Apāna Vāta is controlled and it

subsides the premature contraction and pain. Ojovardhaka &

Prajasthapāna properties prevents premature labour and

stabilizes the Ojas. Arjuna shows Sandhanakara action

which strengthens the uterine musculature and Shonita

Prasadana property which may increase the blood supply of

uterus. Emphasis of Kṣīra in Garbhini is well known with

properties such as Jeevaniya, Rāśayana, Medhya, Balya and

Brimhana.

Increased premature contractions are induced due to the

Vigunya of Apāna Vāta. Basti is the best method to treat

vitiated Vāta.[x] Premature contractions caused due to

constipation are relieved by Basti. The drugs given in Basti

form have specific target action and quick absorption. Kṣīra

Basti normalizes the Vāta by the downward movement and

relieves any sort of pain.

CONCLUSION

As there are no substitutions available for tocolytics till date

to prevent preterm labour. So the premature uterine contrac-

tions may be managed by Ayurvedic drugs after the initial

administration of prophylactic dose of tocolytics.

Śatāvaryādi Kṣīrapāka Basti subsides the premature contrac-

tion by its Balya, Brimhana, Prajasthapāna, Rāśayana etc.

properties & it also improves the perinatal outcome. In this

case study, Śatāvaryādi Kṣīrapāka Basti is found to be very

effective in preventing premature contractions when admin-

istered after seventh month of pregnancy. It is given in Basti

form as larger quantity of drug can be administered for effec-

tive action and quick absorption in this route.

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Source of Support: Nil.

Conflict of Interest: None declared

ΛΛΛΛ

How to cite this article: Alka: Ayurvedic Management of

Premature Uterine Contraction. AAMJ 2018; 1:1672 –

1675.

ayurvedic management of premature uterine...

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