Homoeopathy for Healthy mother & Happy childAnte-natal complaints

Presented by : Dr. anil kumari malhotra

Principal Nehru homoeopathic medical college & hospital

B-block defence colony new delhi.110024

INTRODUCTION

The government of india launched a national campaign on homoeopathy for healthy mother and happy child in november 2007. as anticipated the campaign has generated awareness among policy makers, practitioner of other system of medicine and in the general people about the potential of homoeopathic institutions and practitioners to improve their services for provision of quality health care for women and children.

INTRODUCTIONDelhi govt. has been prompt enough to

adopt this programme (launch of campaign ON homoeopathy for “HEALTHY MOTHER AND HAPPY CHILD”) under the delhi state health mission .

The campaign was formally inaugarated on 24/09/09 by the hon’ble chief minister(smt. Sheila dikshit) & hon’ble health minister(prof. kiran walia ).

I congratulate & thanks govt of delhi for initiating this programme which will take help in promoting the role of homoeopathy in mother & child care.

GOAL

To sensitize the health care professionals, social worker ,policy makers & homoeopathic practitioners in dealing with scope of homoeopathy related to mother & child care.

Primary objective

• To train the homoeopathic physicians in the management of women during pregnancy, childbirth and puerperium and in dealing with common disease conditions of children.

Secondary objective• To bridge the gap between theoretical

knowledge and practice.• To increase co-ordination among the

homoeopathic practitioners.• To create opportunities for interaction

between homoeopathic practitioners & allopathic practitioners in dealing with mother & child related diseases.

• To promote experience sharing & enhance opportunities for compilation of success stories thereby increase evidence base for effectiveness of homoeopathy in mother & child care.

Anticipated OutcomesIt is anticipated that following participation

in this training programme,Homoeopathic physicians would be able to:

• Appreciate their role as primary health care providers for women & children.

• Identify their role in reducing morbidity associated with pregnancy & child birth.

• Recognise the value of holistic & comprehensive management & integrated health care through better co-ordination among homoeopaths,paediatrician & obstetricians.

Conti….

• Appreciate the importance of timely cross-referral in patient care thereby,reducing the mortality associated with mother & child care.

• Establish homoeopathy as the first line of treatment in some of the conditions related to maternal & child health.

ANTE-NATAL COMPLAINTS

NAUSEA & VOMITING• DEFINATION: Feeling of nausea or being sick during

pregnancy is widely known as morning sickness.

it may or may not be associated with vomiting.Incidence occurs in up to 70% of pregnant mother.Normally occurs at about the 6th week &

usually passes off by 12-14 weeks.Can start as early as the missed menstrual

period & may cotinue throughout the pregnancy

Is more common in first pregnancy

ETIOLOGY

Causative factors increased levels of hcg (human chorionic gonadotropin),Hypoglycemia (lower blood suger) during early pregnancy.

Precipitating factor

Psychological factor Travelling Odor of some foods

Other cause of vomitingHepatitisGastroenteritisUrinary tract infectionMigrainePeptic ulcer diseaseAppendicitisCholecystitisPancreatitis

Other cause of vomItingsymptom Probable

diagnosisAnorexiaFeverWeakness & tirednessPain abdomenjaundice

Hepatitis

DiarrheaFeverDehydrationAbdominal cramps

Gastroenteritis

symptom Probable diagnosisFrequency,urgency & painful urinationLower back pain & lower abd painUrine may be cloudy or blood tinged Fever & chill may be present

Urinary tract infection

Throbbing headache which is usually unilateralSensitivity to light ,noise,& odorsLoss of appetiteFatigueDizzinesBlurred vision

Migraine

Burning pain in the middle or upper stomach meals or at nightBloating Heart burnNausea or vomitingDark or black stool

Peptic ulcer disease

symptom Probable diagnosis

Pain around umbilicus shifting to right lower abdomenLoss of appetiteFever Inability to pass flatusTenderness in right iliac region

Appendicitis

Tenderness in the right abdomen Sharp ,cramping pain occuring immediately after meal, radiating to right scapula ,lasting for more than & worse during a deep breathFever

Cholecystitis

Sudden, intense pain in the middle of the abdomen ,12 to 24 hours after a large meal which radiate to back or below the left shoulder blade, worse after eating or drinking & lying backFeverAbdominal distention & tenderness

pancreatitis

General management/conservative treatment

• Advice women toTake small frequent meals instead of three

major meals.Ginger & vitamin B6 rich diet such as whole

grains, nuts, seeds,& legumes may reduce nausea & vomiting

Eat foods in protein, like nuts etc.

Avoid citrus juices, milk, coffee & tea around meals.

Do physical exercises like early morning walk etc.

Homoeopathic management

SepiaGENERALITIES: - CHILLY. - > EVENING. - > EXERTION, VIGOROUS activity. Occupation. - < Before and during menses. - < HORMONAL CHANGES, like menses, abortion,

pregnancy - < 2 to 4 p.m. or 3 to 5 p.m. - < Coition. - < Sea. - < Loss of fluids. - < Left side. - Flushes of heat. - Easily fainting.

Sepia( conted..)

FOOD AND DRINKS: - Desire: Sweets, chocolate,

VINEGAR (salad dressings), SOUR, bread, salt, stimulants. - Aversion: Fat, salt.STOMACH: - Aversion food, even smell of food. - EMPTINESS, NOT > BY EATING. - Nausea and vomiting in pregnancy, < sight or smell of food, morning

before eating.

Arsenic album

Nausea /ratching,vomoting specially after eating & drinking

• Vomiting of foods, drinks,mucous,bile,yellowish, greenish ,browing in colour, violent pain in the abdomen during vomoting

• Can not bear the sight or smell of food.Main symptoms:• - Anxiety, restlessness, weakness.• - < Cold.• - < 0-2 a.m. Midnight.• - Intense thirst for frequent sips.• - Burning pains > heat.• - Periodicity, alternation of symptoms. • Stage 1: mainly physical.• Stage 2: strong anxiety about health + fear being

alone.• Stage 3: obsessive fear of death.• Stage 4: paranoid, suspicious, despair, suicidal.

Arsenic album( contd..)MIND: - Seeking security (selfishness). - Demanding help, company. - FEARS: being alone, cancer, robbers, poverty, DEATH. - Worry things will go wrong, anxiety for others. - RESTLESSNESS, cannot relax, anxious. - Avaricious, collecting. - Fastidious, faultfinding. - Anxiety about health. Later: despair of recovery. - Suicidal. Impulse to kill, fear of killing.GENERALITIES: - CHILLY, > heat. - Right sided. - > Milk, warm drinks.FOOD AND DRINKS: - Desire: lemon, fat, olive oil, lard, alcohol, bread. - Aversion: farinaceous food, beans.

Ipecacuanha

• MIND:• - Full of desires, but doesn't know for what. Feels

unfortunate.• - Impatience. Restless.• - Morose with contempt for everything. Jealous.• - Disposition to be angry. Irritability from noise. • - Ailments from mortification, with indignation;

suppressed anger.• Silent grief.• - Fear of death, with sighing.• - Indifference to pleasure. Joyless.• - Children cry and howl. Hard to please.• GENERALITIES:• - Sensitive to warm and cold.• - < Vomiting.• - Periodicity.• - HEMORRHAGES, bright red.• - Obesity.• - Ailments from suppressed eruptions, anger, vexation.• - Stomach feels relaxed, as if hanging down like a bag.

Ipecacuanha( contd..) STOMACH:• - Uneasiness. Horrid sick feeling.• - NAUSEA, VOMITING. • Vomiting does not relieve.• Nausea but not able to vomit.• < From smell or thought of food, rich

food, ice-cream, sweets.• < Looking at moving objects • < Coughing. With headache. With

hemorrhage.• - Stomach feels relaxed, as if hanging

down like a bag • FOOD AND DRINKS:• - Desire: Indistinct, delicacies.• - Aversion: Food in general.• - < Veal, rich food, raisins.

Colchicum autumnaleMIND: - Discontented. Irritable. - Irritable from the pains. - Ailments from rudeness.GENERALITIES: - < Cold, damp weather. - < Changes of weather, fall, spring time. - < Evening, night. - < Touch, MOTION. - SENSITIVE TO ODORS: nausea, vomiting,

fainting.STOMACH/ABDOMEN: - NAUSEA from SIGHT, ODOR OR THOUGHT OF

FOOD, (esp. odor of fish & eggs). - BLOATING, distention. Trapped gas. - Pain > bending double.

Symphoricarpus racemosa• Indication

Persistant vomiting of pregnancy Deathly nausea & vomiting with

the voilent retching Nausea, vomiting worse by any

motion,better from lying on backBitter testeAversion to all foods.

Nux vomicaSTOMACH: - GASTRITIS. ULCERS. - Nausea and vomiting < anger, vexation, stimulants, abdominal pains. - Retching with inability of vomiting. - Pain < anger, vexation, tight clothes, > warmth, warm drinks. - Sensation of stone after (over-)eating. - Complaints from alcohol abuse.GENERALITIES: - CHILLY. - < Cold, drafts. - < Uncovering a part. - < Morning. - < Dry weather. - < Eating. - > Warmth. - > Wet weather (Caust, Hep). - Anti-peristalsis (vomiting, urine, stool). - Convulsions, < anger. - Apoplexy, with sticking pains in affected limbs. - Fainting from odors, during labor. - Sensitive to all impressions: odors, light, noise, smells, etc.FOOD AND DRINKS: - Desire: SPICES, FAT, ALCOHOL, STIMULANTS. - Aversion: Meat. - < : Stimulants.

Lactic acid

Morning sickness, diabetes, and rheumatism offer a field for this remedy.

Stomach.-Tongue dry, parched. Thirst; voracious hunger.Canker, copious salivation and water-brash. Nausea; morning sickness, especially in

pale anaemic women. Hot, acrid eructation. Nausea; better,

eating. Burning, hot gas from stomach to throat,

causing profuse secretion of tenacious mucus,worse smoking.

pulsatillaNausea & vomiting in evening & night after eating ,drinking

during a mealWater brash with foaul smell from mouth.MIND: - FORSAKEN FEELING, often expressed in the need for attention. - CONSOLATION >. - EMOTIONAL, SYMPATHETIC, WEEPS EASILY.

GENERALITIES: - CHANGEABLE SYMPTOMS. - < SUN, WARM ROOM. - < MENSES, PREGNANCY, MENOPAUSE, SUPPRESSED MENSES. - > OPEN AIR. - > COLD APPLICATIONS (Guai, Lac-c, Led, Sulph). - > Slow motion (Ferr). - WANDERING PAINS (Form, Kali-bi, Kali-s). - Bland, yellow-greenish discharges.FOOD AND DRINKS: - Desire: Cheese, COLD FOOD, CREAMY THINGS, ICE CREAM, (peanut) butter, hard-boiled eggs, sweets. - Aversion: FATS AND RICH FOOD, butter, pork, warm food. - < FATS AND RICH FOOD, ice-cream.

HEART BURN AND INDIGESTION

• Heartburn or pyrosis means substernal pain or burning sensation, usually associated with regugitation of acidic juice into the oesophagus.

• Indigestion is referred to a non specific term for a variety of symptoms resulting from failure of proper absorption of food in the ailmentry canal.It encompasses a variety of upper abdominal complaints like nausea, vomiting,heartburn,regugitation and dyspepsia.

ETIOLOGY

CAUSATIVE FACTORS Diminished muscles tone &

motility of the entire GIT Relaxation of cardiac

sphincter Delayed gastric emptying

with decreased gastric secretion

Displaced abdominal organs due to enlarged uterus

The increasing intra abdominal pressure.

Pregnancy induced hiatus hernia.

EXACERBATING FACTORS

Overeating Eating spicy foods. Eating in the late

hours of evening/ night.

Lying down immediately after meals.

Bending forwards esply after eating.

Homoeopathic management• pulsatilla

MIND: - FORSAKEN FEELING, often expressed in the need for attention. They do anything to fulfil this need. - CONSOLATION >. - Yielding. - EMOTIONAL, SYMPATHETIC, WEEPS EASILY. - Often mild, but can be irritable. - Changeable moods.GENERALITIES: - CHANGEABLE SYMPTOM - WARMBLOODED, < HEAT (but can be chilly). - < SUN, WARM ROOM. - < MENSES, PREGNANCY, MENOPAUSE, SUPPRESSED - > OPEN AIR. - > COLD APPLICATIONS (Guai, Lac-c, Led, Sulph). - WANDERING PAINS (Form, Kali-bi, Kali-s).FOOD AND DRINKS:

- Desire: Cheese, COLD FOOD, CREAMY THINGS, ICE CREAM, (peanut) butter, hard-boiled eggs, sweets. - Aversion: FATS AND RICH FOOD, butter, pork, warm food. - < FATS AND RICH FOOD, ice-cream. eructation bitter & bilious in the evening. heart burn & dispepsia, with great tightness after

a meal; must loose clothing. heart burn with palpitation.

pulsatillaNausea & vomiting in evening & night after eating ,drinking

during a mealWater brash with foaul smell from mouth.MIND: - FORSAKEN FEELING, often expressed in the need for attention. - CONSOLATION >. - EMOTIONAL, SYMPATHETIC, WEEPS EASILY.GENERALITIES: - CHANGEABLE SYMPTOMS. - < SUN, WARM ROOM. - < MENSES, PREGNANCY, MENOPAUSE, SUPPRESSED MENSES. - > OPEN AIR. - > COLD APPLICATIONS (Guai, Lac-c, Led, Sulph). - > Slow motion (Ferr). - WANDERING PAINS (Form, Kali-bi, Kali-s). - Bland, yellow-greenish discharges.FOOD AND DRINKS: - Desire: Cheese, COLD FOOD, CREAMY THINGS, ICE CREAM, (peanut) butter, hard-boiled eggs, sweets. - Aversion: FATS AND RICH FOOD, butter, pork, warm food. - < FATS AND RICH FOOD, ice-cream.

capsicumMIND: HOMESICKNESS. Kind of sweet melancholy, noble sadness. - Offended easily. Ailments from emotional excitement. - Depression, anxiety. Eventually indifference, + des.

stimulants. Clumsy. Indolent. Uncleanliness of body. - Sensitive to noise during chill, acutes.GENERALITIES - Chilly (but + burning pains). - < Cold, stimulants, > heat. - Ulcers, haemorrhoids. - Pain (anywhere) from coughing. Burning & smarting sensation in throat.FOOD AND DRINKS: - Desire: pepper, alcohol, STOMACH: - Nausea after coffee. - Great thirst before, during chill, after stool.

Acetic acidMIND:. Anxiety ab. his children. • - < Emotional excitement.• - Tormenting panic-attacks with feeling of

suffocation.• - Ailments from grief.• - Irritability from headache.• GENERALITIES:• - Anaemia, emaciation, loss of appetite, weakness,

cachexia.• - Night-sweat, burning thirst, cough, diarrhea,

vomiting, polyuria.• - Face pale, waxy, bluish lips, sunken eyes with dark

circles.• - < Cold, sleeping on back• STOMACH:• - Extreme, burning thirst.• Sour belching & vomiting ,burning weter brush &

profuse salivation day & night.

Mag carbmind - Forsaken feeling, FEELS AS IF NOT BELOVED by his parents, friends, etc. - Reserved. Easily hurt and depressed. - Sensitive to noise, touch, etc. - Can be very irritable (Cham). Discontented. - Anxiety and fears all through the day, < warm food, > going to bedGENERALITIES: - Neuralgia's < left side. < Cold, draft. - < MENSES. During pregnancy. < 3 a.m - < After sleep. - > Motion, walking about. - Acidity, SOUR (Hep, Rheum): Smell of body, discharges.FOOD AND DRINKS: - Desire: MEAT, bread and butter, fruit.STOMACH: - Slow digestion. Food becomes sour. - Sour eructations. Heartburn. Gastritis. - Vomiting of undigested milk.

Natrum phosMIND: Sensitive, Sympathetic. Close down easily when hurt. Aversion consolation. - Discontented ,Clairvoyance. - Fear of something will happen < night; bad news, dark,

storm,disease, death. Easily starting, < noise. - Indifference to everything, Weakness of memory.

Dullness.GENERALITIES: - Weakness. - < Coition (Seminal discharges). - < Thunderstorm. - < Mental exertion.FOOD AND DRINKS: - Desire: FRIED EGGS, salt, spices, (fried) fish, beer, ice

cream. - < : Sugar, milk, fat. STOMACH: - Acidity. Sour eructations. - Vomiting of sour, cheesy masses.

CONSTIPATION AND PILES

• Constipation is defined as delay in defecation that is present for 2 weeks or more and which is sufficient to cause significant distress to the pregnant woman. There is departure from the normal stool pattern & is characterised by the passage of hard stool.

ETIOLOGY

CAUSATIVE FACTORS The increased

circulating progestrone levels during pregnancy causing sluggish bowels peristalsis which causes hardening of the stools and constipation.

Compression of intestines by thye gravid uterus in later part of pregnancy.

PRECIPITATING FACTOR

Poor intake of dietary fibre

Poor fluid intake Intake of the oral

iron can worsen the condition.

HEMORRHOIDS/PILES

• Hemorrhoids or piles are dilated veins of the anal canal.

• They may be external or internal to the anal orifice.

The external piles is covered by skin, The internal variety lies beneath the

anal mucus membranes.

ETIOLOGY

CAUSATIVE FACTORS• Compression of the

superior rectal veins by the pregnant uterus.

• The relaxing effect of progesterone on the smooth muscles in the walls of the veins.

• An increased pelvic circulating volume.

EXACERBATING FACTORS• Prolonged

constipation• Straining at stool.• Prolonged sitting.• Spicy foods may

aggravates the problem

• Less frequently ,entritis,colitis,or the dysentry may aggravate latent hemorrhoids.

GENERAL MANAGEMENT

Reassure patient. Follow dietary measure to prevent

constipation & straining. Recommend ‘sitz bat’: a sitz bath is

a warm water bath or saline water used for healing or cleansing purposes.

Empty bowels once the urge comes.

Homoeopathic managementAesculus hip

MIND: Confusion on waking, doesn't recognize anyone, feels himself lost:

disorientated. Anger from disagreement with actions of others. Indolence, > animated conversation, mental stimulation, talking ab.

controversial subject.GENERALITIES: Sensation of internal fullness and external heaviness. Stitching,

shooting, burning pains. < Walking, dur. & after sleep. Superficial pains < winter, cold bathing/air & > summer,deep

disturbances > cold.RECTUM: - HAEMORRHOIDS: Large, painful, purple, protruding piles. Key Note: as if filled with needles or sharp sticks , dry feeling. - PAINS: splinter-like, ext. to sacro-iliac joint & hips, severe pain after stool ,drawing, heavy, full feeling, < standing.

Ammonium murMIND: - Timid. Reserved. - Intellectual, read, study, proud of it. - Can be rude, abusive, malicious, like Sep. Av. certain

persons. - Grief can affect them deeply. Become sulky, withdrawn, taciturn. Des. to cry, but can not (Nat-m). - Irritability > after eating.GENERALITIES: - Profuse discharges, acrid (nose), glairy (lungs,

leucorrhoea). - Always feel tired and sore. After sprains, pain, stiff, frequent lumbago, sciatica > lying. - Key Note: LOCAL PULSATIONS (e.g. eyelids, glands, tonsils,

carotids) - BODY CORPULENT, abdomen fat, LEGS THIN.RECTUM: - Burning pain during and after stool, for hours. Aspecially

after suppressed leucorrhoea. --green mucoid stools alternate with constipation. ---stool hard ,crumbly or covered with glairy mucus.

Obstinate constipation with much flatus.

sulphur• RECTUM: DIARRHEA, DRIVES OUT OF BED IN THE MORNING,, AROUND 5-6

A.M.• - Diarrhea from beer.• - Flatus offensive.• - Hemorrhoids., ITCHING, BURNING < NIGHT, HEAT, > COLD.• - Redness. Moist and eruptions around rectum. • GENERALITIES:• - Intellectual type: Pale, lean.• - Practical type: Plethoric. • - WARMBLOODED. Sometimes chilly. , HEAT, HEAT OF BED.,

11 A.M. STANDING , AND AVERSION BATHING , Night., Climacteric.

• - < SUPPRESSED ERUPTIONS OR DISCHARGE.• - > COLD APPLICATIONS .• - < LEFT SIDE .• - DISCHARGES OFFENSIVE. • - BURNING PAINS.• - Periodicity, 7 days, < week-ends.• - Diabetes.

collinsonia

RECTUM: - HAEMORRHOIDS: chronic ,painful &

bleeding piles. Pain like sticks inside , ALTERNATING WITH HEART TROUBLE. - CONSTIPATION, hard stool. < mental emotion or excitement.

aluminaRECTUM/STOOL: - CONSTIPATION FOR MANY DAYS, with SOFT STOOL. - No urging, have to aid with fingers. Rectum seems

paralyzed. - Perspiration from straining at stool.MIND: - VAGUENESS, no clear symptoms come out.(Stages)1. Slowness. Slow comprehension. 2. CONFUSION. TURMOIL3. Loss of identity. 4. Come to conclusion they are going insane.GENERALITIES: - < Morning, on waking; - < Heat. Potatoes, starchy food. Salt, Cold drinks, food. > Evening, sunset; snow; eating.FOOD AND DRINKS: - Desire: dry food, indigestible things.

Kali carbRECTUM: - Painful hemorrhoids, burning and stitching, < coughing, touch. Has to lie on the

back with nates spread apart . - Constipation, < before and during menses.MIND: - RIGID, INFLEXIBLE, DOGMATIC. - Strong mental controll over emotions and behavior. - Hypersensitive to TOUCH, ticklish. - Fears: being alone, impending disease, dark, - Capriciousness.GENERALITIES: - CHILLY, < cold. - < DRAFT, uncovering, 2-4 A.M.,Coition. - darting & STITCHING pains worse during rest lying on affected side. after loss of fluids or vitality.BACKACHE ,SWEATING & WEAKNESS are characteristic symptom of kali carb.

Nux vomRECTUM:-CONSTIPATION, CONSTANT INEFFECTUAL

URGING.

- Diarrhea with constant urging; alternating with constipation.

- Hemorrhoids. Prolapsus. - Urging for stool while urinating

(Mur-ac); with every labor. pain;during menses.

- Spasms during orgasm.

BACKACHE

Back pain is one of the most common discomforts during pregnamncy.

Half of all pregnant women can expect some back pain.

Tha pregnant patient may develop an unstable pelvis, which produces pain.

The curvature of lumbar spine & cervico-thoracic spine may be increased.

CAUSESo Hormonal changes: the hormones of

pregnancy causes softening of the ligaments supporting the lower spine .this produces tissue laxity & allows increased stretching of the ligaments & the muscles that normally support the spine to relax & become loose.

o Muscle spasmo Urinary infection o Constipationo Faulty posture & high heel causes

lumbar lardosis.

GENERAL MANAGEMENTReassure the womanAdvice woman about:Wearing right footwear with low heel but not flat with

good arch support.Use of a tight maternity girdle to support the

abdominal protusion with frequent bed rest.Application of hot or cold packs or a back rub.Regular exercise can keep the muscles of the back

strong & may relieve back pain.Regular practice of pelvic tilt exercisePracticing good posture & correct way of sitting ,

standing.Taking diet rich in calcium such as milk & its productCalcium supplement may be required by some patients

whose diet is lacking sufficient calcium.

Homoeopathic management• aesculusGENERALITIES: - Sensation of internal fullness and external

heaviness. - Stitching, shooting, burning pains. - < Walking, dur. & after sleep. - Wants to lie, but < lying; > strong motion,

exertion. - Superficial pains < winter, cold bathing/air &

> summer,deep disturbances > cold.BACK: - Severe PAIN (reflex from piles), ext. to hips;

in lumbo-sacral, sacral & sacro-iliac region. - Rheumatic pain sacro-iliac joint (arthritis). < Rising from seat, motion,Stooping,

walking,Before chill; from suppressed menses. - Lameness sacral region on waking.

arnicaMIND: - Think they are well, send doctor away. - FEAR others approaching them, TO BE

TOUCHED, struck. - Fear of wind, sudden death.GENERALITIES: - Complaints ever since a trauma (Nat-

s). - < Cold wet weather. - < Jar.EXTREMITIES: - Arthritis < cold wet weather. - Joint pains < jar (Bell).

Kali carbMIND: - RIGID, INFLEXIBLE, DOGMATIC. - Hypersensitive to TOUCH, ticklish. - Fears: being alone, impending disease, dark,

ghosts, future. - Starting easily, from noise, when touched, during

sleep. - Capriciousness.GENERALITIES: - CHILLY, < cold. - < DRAFT, uncovering, 2-4 A.M, Coition. - STITCHING painsFOOD AND DRINKS: - Desire: Sweets. BACK: - Weakness. Lumbago, sciatica. - PAIN < menses, labor, sitting erect, walking, >

hard pressure. Must sit to turn over in bed (Nux-v).

Rhus toxBACK: - PAIN AND STIFFNESS: < Overlifting, rest, beginning to move, cold wet weather. > Motion, heat, hard pressure, massage. - STIFFNESS OF THE NECK, < DRAFT (Calc-p, Cimic), cold, wet weather. Needs to stretch and move. Massage neck constantly. Muscles bound

up in neck.MIND: - BUSY, RESTLESS. - SUPERSTITIOUS. Compulsive, ritualistic behaviour. - Behavior disorders with restlessness, irritability. - Fear of being poisoned.GENERALITIES: - > MOTION, < BEGINNING TO MOVE. - < REST and < OVER-EXERTION. - < COLD, COLD WET, foggy, cloudy weather, becoming wet. - > WARM AND DRY. HOT BATHING,> Stretching..FOOD AND DRINKS: - Desire: COLD MILK, cold drinks, sweets, cheese, yoghurt, oysters. - Aversion: meat. - < Cold drinks.

Ledum palMIND: - Irritable. Dissatisfied. - Desire for solitude. Misanthrophy. - Restlessness, must constantly move.GENERALITIES: - CHILLY BUT < HEAT. - PAINS > BY COLD APPLICATIONS. - < Heat, heat of bed. - < Night. - COLDNESS OF AFFECTED PART. - Complaints go from below upward . - RHEUMATISM. GOUT. Mainly of lower limbs. AFFECTIONS TRAVELLING UPWARD FROM FEET. > COLD APPLICATIONS (Guaj, Lac-c, Puls,

Sulph). Put their feet in ICE WATER. < HEAT in be

sarsaprilla

• MIND:• - Easily offended. Anger about

former vexations.• - Delusion being friendless.• - Changeable moods.• - Anxiety and depression from pain.• GENERALITIES:• - Chilly, warm applications >• - < Dampness.• - < Night.• - < Before menses.

Varicose vein

IntroductionVaricose vein are dilated, tortuous

superficial vein that result from defective structure & function of the valves within the veins.

Blood pools in sections of the vein, causing the vein to bulge & swell.

These appear as blue or purple veins ; most likely seen in the legs.

About 40% of all pregnant women suffer from varicose veins.

•Etiology • Increased level of progesterone

causesblood vessel to relax. This allows the two halves of the two halves of the vein to seprate slightly,so that they do not meet to block the back-flow of blood.

• The enlarged uterus presses against the major vein in the pelvic region ( inferior vena cava) resulting in an increase in the pressure in the leg vein that are likely to become varicosed.

•predisposing factors• Family history of varicose veins.• Overweight twin or higher multiples.• Standing continuosly for long period.

GENERAL MANAGEMENT Exercise daily. Avoid standing for long periods and try to shift

body weight often from one leg to another while standing.

After many hours o standing , sit and elevate the leg for about an hour.

Elevate feet & leg whenever possible , use stool or box to rest the legs on when sitting , and keep feet elevated on a pillow when lying down.

Wear speacial support hose every morning & remove them at night.

Wear low heeled or sport shoes which help to strengthen calf muscles & improve circulation.

Try to maintain the recommended weight according to the state of pregnancy.

Give reassurance to the patients as varicose vein that develop during pregnancy usually disappear after delivery.

TRENELENBURG’S TEST

• It is test to check the valvular competence of the leg veins in which the leg is raised above the level of the heart until the veins are empty & then the leg is rapidly lowered

TRENELENBURG’S TEST

How to do it ?• Patient lies on his back & raises his leg to

empty the veins.• A tourniquet is applied just below the

saphenous opening.• The patient is then stood up & the tourniquet

is removed in 60 sec.• Normlly the vein should fill from below within

35 sec with the tourniquet in situ.• Earlier filling indicate incompetence of a

communicating vein.• If on release the veins fill rapidly from above it

is due to incompetent sapheno- femoral valves.

Homoeopathic managementBellis pernis

Injuries to deeper tissues after major operation, esp. on pelvis organs.

Traumatism of pelvic organs; ill effects from masturbation.

Sore, bruised feeling in pelvic region (uterus). - Ailments after: cold drinks (cold food, wet chill)

when heated. - Cancer of breast/induration of mammae after

contusion of the breast. - Inability to walk during pregnancy. - Stasis. Fag. - Overworked old labourers, gardeners,

commercial travellers, railway spine. - Boils.

HAMAMELIS - WEAK VEINS. VARICOSITIES. - Hard ,knotty, swollen,& painful veins. - BRUISED SORENESS of affected parts. - PASSIVE VENOUS HEMORRHAGES, dark, profuse. - Distention of veins, large and blue. - < Menses, pregnancy, suppressed menses. - Prostration out of proportion to amount of blood

lost. EXTREMITIES: - VARICOSE VEINS with SORENESS and stinging, < pregnancy, menses . - Thrombophlebitis - Dullness morning on waking. - Thinking constant about his ailments with

complaining.

pulsatillaVaricose veins in legs, worse from letting the affected

limb hang down.Drawing , tearing, erratic pain, rapidly shifting from

one place to another with chilliness.legs feels heavy & weary.

changeable moods.- consolation >. desire for company - emotional, sympathetic, weeps easily changeable

symptoms. warmblooded, < heat (but can be chilly).

- < sun, warm room. - < menses, pregnancy, menopause, suppressed

menses. - < getting feet wet, twilight. - > open air, cold applications ,slow motion - wandering pains

Ferrum metalicum

- Varicosities < during pregnancy . - Cold feet, < evening in bed. SENSITIVE TO NOISE, especially to rustling of

paper. - Dictatorial. Contradiction aggravates. - Irritability, < noise, menses. - Restlessness. Busy.- FALSE PLETHORA: look healthy, red cheeks, but

are very weak. - FLUSHES OF HEAT with strong perspiration. - Obesity. - Weakness. - Anaemia, with local congestions. - > WALKING SLOWLY , but < exertion. - < Rest.- Ailments from loss of fluids .

lycopodium• - Varicose veins of pudenda Drawing & tearing pain in linbs at night & on

alternate day, pain as from contraction in the calves while walking

Swelling of leg & feet ,worse in wet weather , better in warmth

mental - Often intellectual people - Fear of speaking in public, ghosts, dark,

suffering (hypochondriacal), < 4 TO 8 P.M, afternoon. - > Evening., open air. - < Morning on waking, fasting. - Emaciation of upper part of body. Desire: SWEETS, olives. - Aversion: COLD DRINKS, oysters. - < Cabbage, beans, oysters, onions.

Carbo vegMIND: - Indifference, not interested in anything . - Don't want to get up out of bed. - Need mental stimulation. Dullness.GENERALITIES: - IN ACUTES: FAINTING, COLLAPSE: CHILLY, COLD PERSPIRATION, cold breath, from too much food, bloating, from pain. COLD, but want to be FANNED. Desire for OXYGEN. - Affects: 1st stomach, 2nd circulation, 3rd respiration. - Chilly, except in asthma. - > Eructations. < Loss of fluids - < Lying, need pillows . - Blueness, sense of overfulness, ecchymoses, venous

stasis,hemorrhages dark. limbs go to sleep easily. Coldness from knees down, with

cold sweatFOOD AND DRINKS: - Aversion: & < FAT. - Desire: SALT, sweets

Zincum met

Large varicose veins on legs ,Lameness, weakness, trembling and twitching of various muscles.

Feet in continued motion, cannot keep still.. Transverse pains, especially in upperextremity. Soles of feet sensitive. Steps with entire sole of

foot on floor. Toes, feel swollen, sore, tips ache. Bones of the feet feel broken.

Stumbling, spastic gait totters while walking especially in the dark and with

closed eyes. Lightning-like pain of locomotor ataxia, sweaty

feet with sore toes. Formication of feet and legs as of insects crawling

over the skin,prevents sleep, better rubbing and pressure. Hysterical contradictions,drawing the fingers out

of shape. Burning in tibia.

URINARY TRACT INFECTION (UTI)

• Introduction

Urinary tract infection are most common infection during pregnancy .

• Incidence In pregnancy , the rate of progression of

lower UTI to pyleonephritis in pregnancy is reported to be as high as 40%.

UTI

• DEFINITION: UTI is defined as the presence of at least 100,000 organism per million of urine in an asymptomatic patient or as more than 100 organisms per milli litre of urine with accompanying pyuria (>7 WBC/ML) in a symptomatic patient.

Types of UTI

ASYMPTOMATIC BACTERIURIA ( ASB)

UPPER UTI ( CYSTITIS)

LOWER URINARY TRACT INFECTION ( ACUTE PYLEONEPHRITIS)

ASYMPTOMATIC BACTERIURIA

presence of more than 100,000 organism per millilitre in 2 consecutive urine samples in the absence of symptoms .

The most common pathogen in the pregnant woman is E. coli ( isolated in 80- 85 % of culture) .Others are

Klebsilla pneumoniae(5%)Enterobacter species (3%)Group B beta hemolytic

streptococcus(1%)

UPPER UTI ( CYSTITIS)

• Cystitis is an acute inflammation of the urinary bladder characterised by symptoms of dysuria & increased frequency in urination.

PREDISPOSING FACTORS

• Physiological changes during pregnancy.

• Hormonal & mechanical changes increase the risk of the urinary stasis in the pregnancy resulting in UTI.

• Difficulty in maintaining hygiene may also lead to increase in frequency of UTI in pregnant woman.

SOME IMPORTANT POINT

• Untreated upper UTI have been associated with a low birth weight, prematurity, premature labour, HTN.

• There is increased tendency in progression of lower UTI to pyleonephritis in pregnant women.

LOWER UTI(acute pyleonephritis)

• Acute pyleonephritis is an infection of the upper urinary tract, mainly of the renal pelvis, which may involve the renal parenchyma.

Homoeopathic management

• Apis mellifica• MIND:• - Depressed, weeping.• - Sexual and jealous.• - Irritable, aggressive & sensitive.• - Type: strong, down to earth.• GENERALITIES:• - Stinging, BURNING pains.• - Awkwardness, clumsiness, drop things.• - Complaints from suppresion of sex .• - Anaphylaxis from bee sting .• - Fever, heat < 3 p.m. • URINARY:• - Cystitis: burning pain.• - Acute renal FAILURE.

equisetum• GENERALITIES:• - < Right side.• BLADDER:• - CYSTITIS: THE FULLER THE BLADDER, THE LESS• DISCOMFORT.• Less urging and pain when bladder is fuller. Resist the

urging.• Pain at end of urination (Nat-c, Sars).• - Constant desire to urinate without relief from passing

great quantities• of urine. Sensation of fullness after urination.• - Urine flows drop by drop.• - Enuresis in children with dreams or night-mares when

passing urine.• - Incontinence in old women, with involuntary stools.• - Retention and dysuria during pregnancy and after

delivery.• KIDNEYS:• - Pain in region of right kidney extending to lower

abdomen; with• urging to urinate. • URETHRA:• - Burning, cutting in urethra while urinating.

kreosotum• MIND:• - Dissatisfied with everything.• - Cross, wilful, obstinate.• - Restlessness, < evening and at night; must constantly

move.• - Weeping from music and slight emotional causes.• GENERALITIES:• - EXCORIATING, CORROSIVE DISCHARGES.• - Hemorrhages.• - Offensiveness.• - < Left side.,6 p.m. to 6 a.m.Menses, pregnancy• BLADDER:• - Can urinate only when lying. • - Enuresis in first part of night . Difficult to wake child.• - Involuntary urination while coughing, while lying.• URINE:• - Offensive.• - EXCORIATING. Scalding parts.

helonisMIND: - Sadness < on seeing others happy; with aversion to

company. - > When kept busy, occupation of mind, doing something. - Restless. - Irritability from contradiction. Faultfinding. - Hysteria.GENERALITIES: - < Thinking of complaints . - > Mental diversion ,Warm air. - WEAKNESS. - Diabetes. URINE: - Albuminuria during pregnancy - constant aching & extreme tenderness of kidney region

especially at night. --- burning & scalding while urinating . Involuntry passage of

urine after the bladder seems to be emptied. ---urine– profuse ,clear, light colored ,albuminious. - Sensation of soreness & heaviness in pelvis

cantheris

MIND: - Rage. Frenzy. Violence . - Fear of water, mirrors, shining objects .GENERALITIES: - VIOLENT inflammation, rapid & intense,

destructive. - > Warmth, but skin > cold.URINARY: - CYSTITIS: violent burning pain before and/or

during urination, violent TENESMUS, cutting intolerable

urging, few drops of urine, blood, feels like acid, > cold applications ,with genital

excitement, erection,with restlessness, dances around the room in agony, from pain,

urging, sitting >, walking <, pain < drinking.

sarsaparillaMIND: - Easily offended. Anger about former vexations. - Changeable moods. - Anxiety and depression from pain.GENERALITIES: - Chilly, warm applications > - < Dampness, Night., Before menses. BLADDER: - Dysuria in children. Child screams before and during urination. - Urination frequent and copious. - Unable to urinate during the day unless standing. Enuresis at night. Urine

dribbles while sitting. - Air passes from bladder during urination.URETHRA: - PAIN AT END OF URINATION. Severe burning after urination. Pain from urethra back to abdomen.KIDNEYS: - Renal colic. - Pain from right kidney downward.URINE: - Gravel or sediment in urine. Calculi of kidneys or bladder. - Blood in urine.

PEDAL ODEMA

DEFINITION: Odema is the abnormal & excessive build up of fluid in the body.

Dependent edema occurs due to impedance of venous return.

It is commonly seen in the feet & ankles, because of the effect of gravity.

The swelling is the morning on waking but returns later in the day after walking around.

ETIOLOGICAL FACTORS

PHYSIOLOGICAL CAUSATIVE• Retention of the fluid due

to influence of ovarian, placental & steroid hormones.

• Pressure on the veins of the legs by the growing uterus imparing the return of blood from the lower limb

AGGRAVATING FACTORS• Prolonged standing &

sitting

PATHOLOGICAL Pre-eclampsia

Anaemia

Cardic failure

Nephrotic syndrome

Homoeopathic medicineAPOCYNUM CANNABINUM (apoc.) The chilly Apis.ACUTE (common): - Vomiting immediately after drinking few

drops in gastritis. - PMS: vomiting before menses. - Sensation stomach is empty bag, hanging

down, sinking.CHRONIC (rare): - SEVERE OEDEMA. - KN: Oedema & chronic diarrhea (1st remedy). - Oedema of ankles, scrotum, ascites in kidney

failure. - Anasarca (Apis, Ars, Merc-salts). - Scanty urine.STOMACH: - Thirsty

digitalisMIND: Anxiety about conscience. Remorse. Indisposed to speak. Tearful moroseness. Sadness with sleeplessness from heart pains, due to

unhappy love . Weeping from music. Fear that heart will stop if they move (opposite of Gels.). Fear of death, about the future.GENERALITIES: - SLOW PULSE. - Combination of heart and prostate or liver complaints. - < Lying on left side,Exertion, coition.Swelling of the feet.Coldness of hand & feet sensation in legs as if a red –hot

wire suddenly darted through them

ABORTIONSpontaneous abortion : is defined as

the loss of the pregnancy before fetal viability(22 weeksof gestation)

Types of spontaneous abortion Threatened abortion( pregnancy may continue) Inevitable abortion( pregnancy will not continue &

will proceed to incomplete abortion) Incomplete abortion( products of conception

partially expelled) Complete abortion(products of conception

completely expelled) Missed abortion( is a condition when the embryo

dies but the product of conception arre retained in the uterus.

• Induced abortion : is defined as a process by which pregnancy is terminated before fetal viability.

• Septic abortion Is defined as abortion complicated by infection. Sepsis may result from infection if the organism rise

from the lower genital tract following either spontaneous or unsafe abortion.

It is more likely to occur if there are retained products of conception and evacution has been delayed

It is frequent complication of unsafe abortion involving instrunentation.

It is menifested by• Fever• Foul smell vaginal discharge• Pelvic & abdominal pain• Cervical motion tenderness• Peritonitis( varying degree)

• THREATENED ABORTION:It is a clinical entity where the process of expulsion of the products of conception has started but has not progressed to the state from where the recovery is impossible.

• INCIDENCE25% of pregnant women

experience spotting or bleeding early in gestation, 50% of these lose the pregnancy.

ETIOLOGY• Chromosomal abnormalities are most

common reason occuring in 60% of the cases.These include:

• Autosomal trisomy( most common)• 45 x monosomy• Triploidy• Tetraploidy• Translocation• Mosaicism

Work out for the patient with spontaneous abortion

Detailed history & physical examination

Ultrasound to check the fetal viability & cervical incompetence.

Thyroid function test & screening for diabetes mellitus

Cervical culture for Ureaplasma urealyticum.

Screening test for lupus anticoagulant ( APLA) and anticardiopin antibodies (ACA) done only when there is history of habitual abortion or repeated pregnancy loss.

Homoeopathic management

• Sabina MIND:

- Music is intolerable, produces nervousness and sadness. - Sensitive to the slightest noise. - Anxiety about losing the baby when pregnant.. - Sensation of something alive in abdomen.GENERALITIES: - > Open air. - < Warm room, warm bed. Motion. - Tendency to hemorrhages.FOOD AND DRINKS: - Desire: Lemons. Salt. Refreshing things. FEMALE GENITALIA: - PROFUSE UTERINE HEMORRHAGES, BRIGHT RED BLOOD WITH LARGE BLACK CLOTS, with cramping pains. < Motion, but sometimes > walking (menses only when lying down). - Menorrhagia between menses. - UTERINE PAINS: PAIN LOWER BACK EXT. TO PUBIS and thighs. Pain shooting up vagina. PAIN PUBIS AS IF BONE WOULD BREAK OPEN. - Recurrent abortions, esp. in first trimester. - Retained placenta. Intens after-pains. - Inflammation of ovaries and uterus after abortion

Secale corMIND: - Restlessness. - Fear of death and insanity, very suspicious because of it. - Puerperal mania: Exposes the body, tears at genitals, Laughs,

claps her hands over head, beside herselfGENERALITIES: - < HEAT , before & during menses. - > COLD APPLICATION, UNCOVERING.COOL AIR, WANTS TO BE

FANNED. - BURNING PAIN > COLD APPLICATION. - Hemorrhage: PASSIVE, VENOUS, DARK OOZING BLOODFEMALE GENITALIA: - CONTINUOUS PASSIVE HEMORRHAGE OF DARK, THIN BLOOD. - First trimester abortion in women who had lots of babies (=

weakened). Painless hemorrhage. - No expulsive action during labor. Contractions of uterus slow down on standing. - Leucorrhea brown, offensive. - Menstrual colic with exhaustion, coldness and intolerance of heat - Bearing down, > lying doubled up. - Desire: Sour, lemonade.

Crocus sativaMIND: - Hysterical. - Alternating moods: Anger alt. with tenderness, laughing,

singing; cheerfulness alt. with irritability, violence, weeping. - Vivid recollection from music heard. - Laughing immoderate. Children laugh silly on every occasion. - Affectionate. Embraces, kisses everyone.GENERALITIES: - > Open air. - < Warm room, Left side, Menses, pregnancy, menopause. - HEMORRHAGE: dark, STRINGY, clotted - Faintness < after labor, post-partum. - Numbness in single parts. FEMALE GENITALIA: - Metrorrhagia: Dark, stringy, clotted. < Least motion (Erig), overheating, during labor, menopause. - Abortion.

Actea racemosaMIND: - HYSTERICAL. - LOQUACITY, changing subjects. SIGHING Depression, suicidal. Dream of impending evil. - Mental & physical symptoms alternate. - Fear insanity, death, rats. - Delusions: heavy black clouds enveloped her, that she will become insane,GENERALITIES: - < Cold, draft. - < Emotional causes. Around menses - PAINS: neuralgic, shooting downward, radiating, go all over (Berb), sharp, stitching, changeable. - Chorea: around menses, with rheumatism, of side lain on.GENITALIA: - DYSMENORRHOEA: cramping, shooting pain pelvis, < when flow gets heavier ,with rheumatism. - Pain from ovary to ovary. - Menses/lochia suppressed from emotion, from cold. Intolerable after-pains.

sepia• MIND:• - Excitable, sensitive• - Lacking of emotions. INDIFFERENCE TO LOVED ONES. Become• hard. • - Depression < menses.• - Dullness, sluggishness.• - Fear: storms, ghosts, poverty.• GENERALITIES:• - CHILLY.• - > EVENING.EXERTION, VIGOROUS activity. Occupation.• - < Before and during menses , HORMONAL CHANGES, like menses, abortion,

pregnancy , Coition• - Flushes of heat.• FOOD AND DRINKS:• - Desire: Sweets, chocolate, VINEGAR (salad dressings), bread, salt, stimulants.• - Aversion: Fat, salt. • FEMALE GENITALIA:• - AVERSION SEX, < hormonal changes. • - Painful coition. Pains shoot up vagina.• < pregnancy, with much itching.• - PROLAPSE OF UTERUS. BEARING-DOWN > SITTING WITH• LEGS CROSSED • - INFERTILITY. HABITUAL ABORTIONS third to fifth month.• - Very sensitive to movement of foetus and to touching uterus .• - Tight os during labour.

heloniasMIND: - Sadness < on seeing others happy; with aversion to

company. - > When kept busy, occupation of mind, doing

something. - Restless. - Irritability from contradiction. Faultfinding. - Hysteria.GENERALITIES: - < Thinking of complaints - > Mental diversion , Warm air. - WEAKNESS. FEMALE GENITALIA: - WEAKNESS, ATONY OF UTERUS. - CONSCIOUS OF UTERUS: feels as if pregnant, feels uterus move, bump when they move. Weight and soreness. - Prolapse, malposition of uterus, < after miscarriage,

pregnancy, - Desire lost. Sterility.Abortion. - Ulceration of cervix. Fibroids.

Viburnum opulus MIND: - Fear baby will die or will be unhealthy. - Can close of emotions. Indifferent.GENERALITIES: - < Warm room , Lying on affected side. - > Open air. Rest.FEMALE GENITALIA: - CRAMPING PAINS FROM ABDOMEN GOING DOWN

THIGHS. - PAINS FROM THE BACK AROUND THE PELVIS AND TO ANTERIOR MUSCLES OF THIGHS.

- Frequent and early miscarriage. - False labor-pains. After-pains. - Very conscious of internal sexual organs .

Bearing-down. - Leucorrhea < during stool.

ANXIETY AND FEAR Defination

Tocophobia also known as ‘fear of pregnancy’ & fear of children is a pathological fear of pregnancy & can lead to avoidance of childbirth.

Anxity during pregnancy can be eitherA women’s general tendency to become anxious in

stressful situations orRecent onset of anxious symptom such as tension

& worry orAnxity symptoms associated with the pregnancy

can be compounded by pre-existing problem

Tocophobia

Primary-Morbid fear of childbirth in a women, who has had no previous experience of pregnancy.

Secondary-Morbid fear of childbirth developing after a traumatic obstetric event in a previous pregnancy.Second to depressive illness in pregnancy.

• Anxiety & appehensions during pregnancy could be

Fear of miscarriage or lossing pregnancy.Physical change that occur during

pregnancy & after delivery.Anxiety about sex of the child.Fear of bearing a malfored child

(teratophobia)Anxiety about labor & delivery .Anxiety about health & wellbeing of the

baby.Anxiety about being a good mother & if she

will be able to take proper care of the newborn.

Manifestations of anxietyAnxiety may manifest as;Changes in emotionsChanges in behaviorPhysical symptoms;RestlessnessNervousnessSleeplessnessCrying episodes or even tacchycardiaChange in eating habits or physical activity.Some women feel paranoid & unable to

enjoy pregnancy ,while other may wish to have a cessarean section beccause of fear of vaginal delivery

Adverse effect associated with undue stress & anxiety during pregnancy

In womenSocial effectsImpacts the quality of lifeMay cause problem in social & professional lifeMedical effectIncreased risk of ;MiscarriagePreterm deliveryPre-eclampsia

In children Increased risk

of ;Low birth weight

babyAttention deficit

hypreactivity disorder (ADHD)

Anxiety disorders

A pregnant women presenting with one or more of the following symptoms

Feeling of being unwellPoor concentrationMood swings-laughing or crying over

trivial mattersFeeling of dreadLack of ability to speak or think clearlyForgetfulnessPanic attacksShortness of breath or rapid breathingPalpitationNauseaExcessive sweating

Take detailed history

Perform respiratory examination: particularly in patients with symptoms of breathlessness/rapid breathing

Do cardiac evaluation: particularly in patients with palpitation & breathlessness.

History of complications in previous pregnancy,labor or delivery ,miscarriages ,death of a baby etc.

History of anxiety in previous pregnancies

Treat for anxiety: Reassure patient Start appropriate homoeopathic treatment Advice general management

Assess after 10-15 days

Improvement

No improvement

Continue treatment

Refer to psychology for psychotherapy,

using interpersonal

psychotherapy or cognitive-behavioral techniques

GENERAL MANAGEMENT

Encourage woman to discuss the fears and anxieties with spouse, friends and relatives.

Advise women to attend antenatal classes and group discussion.

Advise spouse and family members to provide emotional support to the family.

Respiratiry examination

Breath sounds-normalNo added soundsTreat for anxiety

Breath sounds-not normalRonchi or rales-present

Assess further for respiratory diseasesTreat appropriately If improvement –continue the treatment If no improvement – refer to the

speacialist

CARDIAC EVALUATION• CHECK PULSEIF regular treat for the anxiety.

If irregular than suspect arrythmia- refer to the speacialist

for further assesment and management.

• CHECK BLOOD PRESSUREIF normal than treat for the anxiety.

If it is more than 140/90 than refer to the speacialist for

further assesment.• AUSCULTATIONIF normal than treat for anxiety .If diasystolic murmur,loud systole murmur with thrill than

suspect cardiac disease and refer to the speacialist.

Homoeopathic management

ACONITE - After strong FRIGHT, SHOCK. - Experience of IMMINENT DEATH. - FEAR & PREDICTING DEATH.- Sudden, violent. Like internal earthquake. - Palpitations, red face. - Vertigo, one sided numbness, faintness, fear fainting. - Perspiration, trembling, dyspnoea. - FEARS: crowd, narrow places, open spaces, darkness, elevator, tunnel, heart-disease, heart will stop, fainting, air plane, earthquake. - Convinced they will die, predict the time. - Fear of death in labor. - Anxiety about others. - Desire company. - Fearful restlessness. - Desire open air.< cold dry weather, dry COLD WIND, east wind, < becoming cold when overheated.

Arsenic album - Anxiety, restlessness, weakness. - Anxiety about

health. Later: despair of recovery. - Demanding help, company. - FEARS: being alone, cancer, robbers, poverty,

DEATH. - Worry things will go wrong, anxiety for others. - RESTLESSNESS, cannot relax, anxious. Intense thirst for frequent sips. - Burning pains > heat. - Seeking security (selfishness). - Avaricious, collecting. - Fastidious, faultfinding.

- Desire: lemon, fat, olive oil, lard, alcohol, bread. - Aversion: farinaceous food, beans. - Thirst for small quantities frequently.

Actea racemosa- HYSTERICAL. Excitable, very extroverted. - LOQUACITY, changing . Vague, unclear in her descriptions. Can't think straight, give proper answers. - Forceful. - Depression, suicidal. Dream of impending evil. - Mental & physical symptoms alternate. - Fear insanity, death, rats. - Delusions: heavy black clouds enveloped her, that she will become insane, sees sheep, encaged/caught in wires.Mania following disappearance of neuralgia,

neuralgic & rheumatic subjects,tendency to abortion at third month.

Ignatia amara - Ailments from grief, disappointment. - Unable to cry. Cries when alone. Sobbing. Tries to control

crying during interview. - Brooding. SILENT GRIEF , SIGHING. - Changeable moods. UNPREDICTABLE. Hysterical. - Women's liberation. Wants to proove herself. - Gets overstrained, frustrated. Conflict between her

(romantic)nature and her work. Become tense, sharp. - Fear of birds (poultry), claustrofobia, insanity. Anxiety

about health. - Paradoxical, CONTRADICTORY symptoms: e.g. nausea >

eating heavy food. - ALIMENTS FROM GRIEF, EMOTIONAL SHOCK. - Hysterical tendency and symptoms: > Travelling. - Hirsutism. - Intolerant or aversion of tobacco.- Des. Cheese, fruit.

Nux moschata - Absent-minded. - DULLNESS. SLEEPINESS. - Confusion, spaced-out feeling . Feels strange, intoxicated, with irresistible drowsiness. - Alternating moods. Hilarity alternating with dullness. - FORGETFUL for what was about to do. Weakness of memory. - Answers slowly . - Bewildered, as if in a dream. - Surroundings seemed changed. Doesn't recognise well-known streets. - Stupefaction, < menses, pregnancy; comes to herself with a

start. - Seems to be two persons, real self seems to be watching

other self Delusion has two heads.- Chilly - > Dry, warm. - < Windy, stormy weather. Changes of weather , Menses.

Pregnancy. Suppressed menses. - NARCOLEPSY; fights to stay awake. - FAINTING fits: from pains, hysteria, sight of blood.

pulsatillafORSAKEN FEELING, often expressed in the need for attention. Yielding. - Often mild, but can be irritable. - - Jealous, Irritability before menses. - Fears: men (i.e. opposite sex), dark, heights, narrow places. - Fixed ideas, dogma's, can be of a religious kind. - Praying.CHANGEABLE MOODS.- CONSOLATION >. DESIRE FOR COMPANY - EMOTIONAL, SYMPATHETIC, WEEPS EASILY. - CHANGEABLE SYMPTOMS. - WARMBLOODED, < HEAT (but can be

chilly). - < SUN, WARM ROOM. , MENSES, PREGNANCY, MENOPAUSE,

SUPPRESSED MENSES. - < Getting feet wet, twilight. - > OPEN AIR., COLD APPLICATIONS , Slow motion - WANDERING PAINS :Thirstless with great dryness of mouth - Desire: Cheese, COLD FOOD, CREAMY THINGS, ICE CREAM, (peanut) butter, hard-boiled eggs, sweets. - Aversion: FATS AND RICH FOOD, butter, pork, warm food. - < FATS AND RICH FOOD, ice-cream.Often indicated after abuse or over use of iron tonic

IRON DEFICIENCY ANAEMIA

• Definition: anaemia is defined as reduction in circulating Hb mass below the critical level . The nomal Hb concentration in the body is between 12-14gms%.

• WHO has accepted upto 11gm%as the normal Hb level in pregnancy . Therefore any Hb level level below 11gm% in pregnancy should be considered as anaemia.

• However , in india the lower limit is often accepted as 10 gms%.

causes• Physiological There is disproportionate increase of plasma volume during pregnancy leading to

apparent reduction of RBCs, hemoglobin & hematocreit value.hemoglobin is consequently reduced to varying extent sometimes as low as 80%.

The blood picture in peripheral smear is normochromic & normocytic.AcquiredNutritionalIron deficiency anemia(60%)Macrocytic anemia(10%) due to deficiency of folic acid & /or vitamin B12 HemolyticHemoglobinipathiesDrug reactionInfestation with malaria parasitesHemorrhagicDue to acute blood lossChronic blood loss(hook worm,bleeding piles)

Anaemia may be a risk factor for

Fetal,neonatal & infant• Prematurity • Low birth weight• Poor apgar score• Fetal distress • Neonatal distress requiring prolonged

resuscitation• Neonatal anaenmia due to poor reserveInfant with anaemia have higher prevalance of

• Faliure to thrive• Poorer intellectual devlopmental milestones• Higher rate of morbidity & neonatal mortality

than infant with out anaemia.

Anaemia risk factor for mother (Conted..

(mother)During antenatal period Poor weight gain , Pre-term labour Pregnancy induced hypertension Placenta previa Accidental hemorrhage Eclampsia Pre mature rupture of membrane (mother)During intra natal period Dysfunction labour Intra natal hemorrhage Shock Cardiac failure

During post natal period Post natal sepsis Sub involution of uterus embolism

A pregnant women with anaemia may present with

• Vague complaints of ill health• Fatigue• Weakness• Anorexia• Digestive upset• Pica• dyspnea • PalpitationOn examination Pallor Edema in severe case

Iron & folate supplementsProphylactic dose one tablet of 100 mg elemental

iron & 0.5 mg of folic acid once a day for at least 100 days.

Therapeutic dose If hemoglobin < 11 g /dl- 100

mg elemental iron & 0.5 mg of folic acid twice /day for three month

Symptom of side effect of iron supplements

• Nausea• Vomiting• Abdominal discomfort• Constipation• Diarrhoea• Skin rashes• Metallic taste in mouth

Timing of oral iron intake in relation to food

• Foods which interfere with absorption of iron should be avoided along with iron supplement.this include

• Phytates (cereals,bran,& legumes)

• Tannis (green & black tea, wine ,pomegranates & coffee)

• Phosphates ,oxalates & carbonates (vegetables,eggs & milk)

• Increased intake of vitamin C rich food ( guava,lemon,amla,orange,spinach) absorption

of iron is increased in presences of vitamin C .

PROPHYLAXIS

• ROUTINE SCRENING FOR ANAEMIA FOR ADOLESCENT GIRLS from school days & improve iron supplementation if needed

• Encouraging iron rich foods.• Fortification of widely consumed

food wiyh iron.• Regular screening for those with risk

factors.

Send for referral if

• Patient not responding to the therapy

• Complicated sevear anaemia case with other co morbidity like heart failure,palpitation,infection.etc

• Complication of pregnancy associated with anaemia.

Homoeopathic management

• ALETRIS FARINOSA

Aletris farinosa is characterized by weariness of body and mind. The patient is tired all the time , remedy for anemia due to nutritional disturbance, debilitated, relaxed females who always feel tired. They suffer from prolapse, leucorrhea, rectal distress, have muscular pains, tendency for threatened abortion.

Lack of appetite, especially in connection with uterine disorders. Disgust for food, nausea, constipation. The least food distends the stomach. Better by passing flatus, worse from loss of fluid , anaemic relax condition both mentally & physically.Emaciation is marked in some cases.

PULSATILLA CHANGEABLE MOODS.- CONSOLATION >. DESIRE FOR COMPANY - EMOTIONAL, SYMPATHETIC, WEEPS EASILY. CHANGEABLE SYMPTOMS. WARMBLOODED, < HEAT (but can be chilly). - < SUN, WARM ROOM., MENSES, PREGNANCY, MENOPAUSE,

SUPPRESSED MENSES. - < Getting feet wet, twilight. - > OPEN AIR., COLD APPLICATIONS, Slow motion - WANDERING PAINS Thirstless with great dryness of mouth - Desire: Cheese, COLD FOOD, CREAMY THINGS, ICE CREAM, (peanut) butter, hard-boiled eggs, sweets. - Aversion: FATS AND RICH FOOD, butter, pork, warm food. - < FATS AND RICH FOOD, ice-cream.Often indicated after abuse or over use of iron tonics.

sepiaMIND: - Excitable, sensitive. - Close-up, become introverted, averse to company, > WHILE ALONE. - Lacking of emotions. INDIFFERENCE TO LOVED ONES. Become hard. - Constant weeping, because of guilt and awareness of emotional changes. Weeping when telling symptoms. - Dullness, sluggishness. - Fear: storms, ghosts, poverty.GENERALITIES: - CHILLY. - > EVENING. , EXERTION, VIGOROUS activity. Occupation. - < Before and during menses. , HORMONAL CHANGES, like menses,

abortion, pregnancy, < 2 to 4 p.m. or 3 to 5 p.m. , Coition. , Sea , Loss of fluids. Left side. - Ailments from drug abuse and spiritual seeking where suppression of

emotions is stimulated. - Flushes of heat., Easily fainting. FOOD AND DRINKS: - Desire: Sweets, chocolate, VINEGAR (salad dressings), SOUR, bread,

salt, stimulants. - Aversion: Fat, salt.

Ferrum phosAnaemic patient with violent local

congestion, night sweat due to anaemia HEMORRHAGES, bright red blood,

aversion to meat & milk desire for stimulants & sour , Nervous. Sensitive. Irritable.

Irritated at own mental slowness.Easy flushing of face & marked prostration, pulse quick,soft,& full,drowsiness & restless.

Confusion > washing face with cold water, motion.

> Gentle motion, > Cold applications.

Calc phos

Anaemia due to nutritional disturbance after acute disease & chronic wasting disease, pale yellow face,chlorosis with wax like complexion, dull headache particularly on the top of the head , head sensitive to jar & pressure.thin spare & delicate women; numbness & crawling are characteristic sensations; tendency for easy perspiration.

Aversion to routine work. Desire to travel , from discontent. Ailments from grief: Desire: smoked meat ,raw salt, sweets.< Cold wet weather, esp. melting snow., <

Draft. < Mental exertion, stress.

chinaGradually progressive anaemia,face pale, hippocratic,eyes

sunken & surrunded by blue rings,weakness Touchy. Nervous, Complaints after LOSS OF FLUIDS (e.g.

menses, nursing, diarrhea):

pallor, anaemia, weakness. Pale sickly expression, sensitive to draft of cold air Chilly.

Desire: SWEETS, highly seasoned food, salt, pungent. Aversion: fat, fruit.sensitive, easily hurt, offended. Difficult to express

feelings. Introverted.they will do & being the hero of the situation. Fear

animals, dogs. Fear of instincts. < SLIGHT TOUCH. > HARD PRESSURE.Periodicity, every

other day. < Fruit, fish (diarrhea). < Milk. Prostration after acute diseases.

NATRUM MUR• Anemia headache , from sunrise to sunset, with pale

face , nausea & vomiting.

• Dyspnoea while ascending stairs or from physical exertion.

• Maximum weakness is felt in the morning .

• Tachycardia,palpitation, fluttering,& intermittent action of the heart, hot patient ,emaciated, craving for salt, aversion to bread, wine & fat things, increased thirst, mapped tongue,constipation, graet weakness & weariness ,oversensitive to all influences,aggravation noise, music,sad,melancholic,hysterical, weeping alternating with laughter,silent grief, weeping mood,wants to be alone to cry, consolation aggravation.