yoni samavaranam
DESCRIPTION
probable ayurvedic explaination of obstructed labourTRANSCRIPT
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