E-ISSN:2456-3110

Review Article

Garbhasravi Vandhyatwa

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 6 JUNE
Publisherwww.maharshicharaka.in

Ayurvedic management of Garbhasravi Vandhyatwa w.s.r. to Recurrent Pregnancy Loss - A Case Study

Prabhu P1*, Sheela M2, Sridevi S3, Ishwari P4, Sonalika H5
DOI:10.21760/jaims.9.6.58

1* Princy Prabhu, Post Graduate Scholar, Pg Department of Prasuti Tantra Stree Roga, Nk Jabshetty Ayurvedic Medical College and Research Centre, Bidar, Karnataka, India.

2 Mallikarjun Sheela, Professor, PG Department of Prasuti Tantra Stree Roga, NK Jabshetty Ayurvedic Medical College and Research Centre, Bidar, Karnataka, India.

3 Swamy Sridevi, Professor HOD, PG Department of Prasuti Tantra Stree Roga, NK Jabshetty Ayurvedic Medical College and Research Centre, Bidar, Karnataka, India.

4 Patil Ishwari, Associate Professor, PG Department of Prasuti Tantra Stree Roga, NK Jabshetty Ayurvedic Medical College and Research Centre, Bidar, Karnataka, India.

5 Hiremath Sonalika, Assistant Professor, PG Department of Prasuti Tantra Stree Roga, NK Jabshetty Ayurvedic Medical College and Research Centre, Bidar, Karnataka, India.

Pregnancy is the start of an incredible journey that leads to great emotional fulfillment to women. Recurrent Pregnancy Loss (RPL) is defined as two or more failed clinical pregnancies confirmed by sonography or histopathology before 20 weeks. It is relatively common event occurring in 15-25% of pregnancies and increasing in prevalence with maternal age which in turn leads to infertility. The common causes of the first trimester abortion are genetic factors, immune and endocrine factors, infection and unexplained ones in the majority of the cases. In Ayurveda, based on clinical features Recurrent Pregnancy Loss can be correlated with Garbhasravi Vandhya mentioned in Harita Samhita and Putraghni Yonivyapath explained in Brihatrayees. Ayurveda describes many oral formulations along with Shodhana Chikitsa followed by Sthanika Chikitsas like Yoni Pichu, Yoni Poorana, Uttara Basti etc. giving effective sequel in Garbhasravi Vandhyatwa. Here, a mid aged 26 years old patient presenting with recurrent pregnancy loss was given with few oral medications and Shodhana Chikitsa i.e., Virechana Karma and Yoga Basti followed by Uttara Basti for her healthy uneventful pregnancy.

Keywords: Princy Prabhu et al. Ayurvedic management of Garbhasravi Vandhyatwa

Corresponding Author How to Cite this Article To Browse
Princy Prabhu, Post Graduate Scholar, Pg Department of Prasuti Tantra Stree Roga, Nk Jabshetty Ayurvedic Medical College and Research Centre, Bidar, Karnataka, India.
Email: 		Prabhu P, Sheela M, Sridevi S, Ishwari P, Sonalika H, Ayurvedic management of Garbhasravi Vandhyatwa w.s.r. to Recurrent Pregnancy Loss - A Case Study. J Ayu Int Med Sci. 2024;9(6):351-356.
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https://jaims.in/jaims/article/view/3519

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-04-14 2024-05-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Authors state no conflict of interest. Non Funded. The conducted research is not related to either human or animals use. 13.14 All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

© 2024by Prabhu P, Sheela M, Sridevi S, Ishwari P, Sonalika Hand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2024;9(6)351
Princy Prabhu et al. Ayurvedic management of Garbhasravi Vandhyatwa

Introduction

Motherhood is a blessing. Female carries most active role in an intra-uterine as well as extra-uterine growth of a child, hence a sound reproductive health is must. To have a healthy progeny, maintenance of pregnancy till full term is important. Recurrent Pregnancy Loss is defined as sequence of 2 or more spontaneous abortions as documented by either sonography or on histopathology, before 20 weeks (ASRM-2013).[1]

It is one of the most distressing problems in obstetrics. It causes emotional and personal trauma to a young couple who is planning to start a family. This distressing problem is affecting approximately 1% of all women of reproductive age. The risk increases with each successive abortion reaching over 30% after three consecutive losses.[1]

The causes of recurrent abortion are complex and most often obscure which can be considered for first trimester abortions are genetic factors, Endocrine and metabolic, Hyperprolactinemia, Infection, Immune factors, inherited Thrombophilia and majority are unexplained. In the second trimester, Defective Mullerian fusion is the main causative factor along with chronic maternal illness, infection and unexplained.[2]

In Ayurvedic classics, the expulsion of fetus up to fourth month of pregnancy is termed as Garbha-srava, there after in fifth and sixth months it is termed as Garbhapata.[3] Whereas Bhoja opines that the period of Garbhasrava is upto three months.[4]

Putraghni is a clinical entity characterized by RPL due to excessive Ruksha Ahara and Vihara. This leads to Vata Prakopa vitiating Shonita resulting in Arthava Dushti.[5]

Garbhasravi Vandhya is described in Harita Samhita under Vandhya classification. Thus, Recurrent Pregnancy Loss can be correlated to Putraghni Yonivyapad or Garbhasravi Vandhyatwa. Acc, to Acharya Sushruta, Rutu, Kshetra, Ambu and Beeja are the 4 essential factors responsible for occurrence and continuation of the healthy pregnancy.[6]

Aharaja, Viharaja, Manasika Nidanas leads to Artava Dushti (menstrual irregularities) and Apanakshetra Vikruti which alters the pregnancy/conception.

In Ayurvedic classics, numerous formulations have been advised for the treatment of Vandhyatwa. Shodhana Karma (Sarvadaihika) and Sthanika Chikitsa (Uttara Basti) along with oral medications have been taken in this case study. Shodhana Chikitsa is helpful in Bahudosha Avastha by improving the 4 essential factors and removes Srotoavarodha which are responsible for uneventful pregnancy. Shodhana Chikitsa like Virechana Karma, Niruha basti, Anuvasana Basti with Pitta-Asrahara Dravyas helps in improving the Jataragni and Dhatwagni, removing Doshas and balancing in Apana Vayu. Uttara Basti normalizes the Vata and helps in achieving Avyapanna Garbha Sambhava Samagri.

Case Summary

Patient Information
A female patient of 26 years, a doctor, registered in OPD, Department of Prasuti Tantra and Stree Roga, NK Jabshetty Ayurvedic Medical College, Bidar, Karnataka on 1-3-2022 with the complaints of repeated pregnancy loss for 3 times, came for evaluation and to get an uneventful pregnancy.

Patient has 5 years of marital life, belongs to mid socio-economic class.

Menstrual HistoryObstetric History (P0L0A3D0)
Menarche - @13 yearsA1 - at 6 weeks of pregnancy - Spontaneous Abortion (14/3/2020)
LMP - 9/10/2022A2 - at 7 weeks 2 days of pregnancy - spontaneous abortion (20/02/2021)
Regularity - RegularA3 - at 7 weeks of pregnancy- spontaneous abortion (2/3/2022)
Interval of Bleeding - 30-35 days
Duration of Bleeding - 5-6 days
Amount of Bleeding - 2-3 pads/day

History of past illness: No past medical or surgical history

Family history: All the family members are said to be healthy.

Personal history
Diet: Vegetarian
Appetite : Good
Sleep :Sound
Bowl :1-2 times/day
Maturation - 4-5times/day


J Ayu Int Med Sci 2024;9(6)352
Princy Prabhu et al. Ayurvedic management of Garbhasravi Vandhyatwa

General Examination
Built :Lean
Nourishment : Average
Height : 155cm
Weight : 54kg
Blood Pressure : 110/80mmHg
Pulse : 82bpm
Temperature - Afebrile

Systemic examination
CVS: S1 and S2 heard
CNS: Conscious and Oriented
RS: Bilateral air entry clear

Local examination
Per abdomen Examination: soft and non-tender
Per Vaginal Examination: Uterus Anteverted and Anteflexed, normal in its size and shape, Both fornices are free.
Per speculum examination :Cervix healthy

Ashtavidha Pareeksha
Nadi :82bpm
Mala :Prakrita (1-2times/day)
Mutra :Prakrita (4-5times/day)
Jihwa : Nirlipta
Shabdha : Prakrita
Sparsha :Prakrita
Drik : Prakrita
Aakriti : Madhyama

Dashavidha Pareeksha
Prakriti : Vata-Pitta
Vikriti : Tridoshs, Rasa, Rakta
Satva :Madhyama
Sara : Madhyama
Samhanana : Madhyama
Satmya : Madhyama
Pramana : Madhyama
Ahara Shakti : Madhyama
Vyayama Shakti : Madhyama
Vaya : Madhyama

Investigations

  • Hb : 10 gm%
  • Blood group : B +ve
  • WBC :10,000 cells/cumm
  • RBC :3.5 mil/cumm
  • Platelet count - 2 L/cumm
  • RBS :88mg/dl
  • T3 :141ng/dl
  • T4 :10ng/dls
  • TSH :2.059 μIU/ml
  • Urine Routine : Normal
  • HIV, HBsAg : Negative
  • Husband factors : Semen Analysis - within normal limits

Therapeutic Intervention
Initially, Satvaavajaya Chikitsa was adopted explained treatment protocol and with her consent treatment was administered.

Shamanaushadhi:Phalasarpi, Syp. KP tone, Dashomoolarishta

Preconception: Shodhana Chikitsa

Virechana Karma
DurationTreatmentMedicineDose
Day 1- Day 5Agni Deepana and PachanaAgnitundi Vati2 BD
Day 6- Day 8SnehapanaPhalasarpi30, 50, 110ml
Day 9 & Day 10Sarvanga Abhyanga and Bashpa SvedaBala Taila and Sveda with Vatahara Dravyas
Day 11VirechanaTrivrut Avalehya50gms
Patient had 15 Vegas Madhyama Shudhi

Yoga Basti - for 3 sittings
Niruha with Dashamula Niruha Basti
Madhu40mlAnuvasana Basti with Shatapushpa Shatavari Taila - 80ml
Saindhava Lavana5gms
Shatapushpa Shatavari Taila100ml
Shatapushpa Kalka30gms
Dashamula Kwatha400ml

Uttara Basti - for 3 sittings
DurationDose
5 days for 3 consecutive menstrual cycles (from 7th day of LMP i.e. after cessation of mensus)2-3ml

Postconception:

DateTreatment givenObservation
23/11/22 to Throughout pregnancy§ Phalasarpi 1 tsp BD with milk before food § Syp. Mannol 10ml BD after food § Tab. Sujat 1BD after food§ Pregnancy continued without any signs of abortion. § Fetus was healthy and normal growth of fetus was observed.
Patient was under regular ANC checkup till delivery§ Tab Orofer XT 1 OD after food § Tab Shelcal 1 OD after food § Tab Aspisol 75mg 1 ODA healthy live female baby was delivered by LSCS, and baby don`t have any congenital anomalies.

J Ayu Int Med Sci 2024;9(6)353
Princy Prabhu et al. Ayurvedic management of Garbhasravi Vandhyatwa

Observations

jaims 3519 00
Picture 1

jaims 3519 01
Picture 2

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Picture 3

Picture 1, 2 and 3 shows recurrent abortions previously to the treatment.

Results

After treatment, patient reported with amenorrhea and found Urine Pregnancy Test positive. Confirmed by USG - Early Pregnancy Scan (Picture 4), as early single intrauterine pregnancy. Picture 5 shows third trimester scan.

jaims 3519 03
Picture 4


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Princy Prabhu et al. Ayurvedic management of Garbhasravi Vandhyatwa

LMP - 9/10/2022   

EDD - 16/7/2023 

Patient delivered a single male healthy baby on July 18, 2023.

Mode of Delivery - LSCS

jaims 3519 04
Picture 5

Discussion

The importance of a woman lies in her procreative capability, the reason for being worshipped and considered next to god. Vandhya Yonivyapad and Vandhyatwa are two different entities former being amenorrhea latter is considered as Infertility. Hence, here it’s considered as Vandhytwa. Ayurveda gives elaborative description of female infertility and its management. Acharya Harita, gives 6 types of Vandhyatwa,[7]

Garbhasravi being one among them. Prevention is better than cure. In Ayurveda, we get an intricated explanation on Garbhadana Vidhi (Preconception Care) which starts from age of marriage and ends with conception. As a Garbhadhana Purvakarma, Shodhana has been told i.e., Sneha, Sveda, Vamana, Virechana & Basti.[8] Hence it has given more importance to Rutu, Kshetra, Ambu and Beeja which are almost required for healthy conception and uneventful pregnancy. In this case patient had spontaneous abortion for 3 times, all her investigations were within normal range contemplating it to be an unexplained RPL.

Treatment protocol started from Agni Deepana & Pachana followed by Shodhana Karma (Virechana and Yoga Basti) and as a Sthanika Chikitsa Uttara Basti was administered.

Discussion on treatment

In Vandhyatwa, Chikitsa should be aimed at rectifying cause hence a single line of management cannot be applied. In our classics, Chikitsa is advised according to Dosha & Dhatu involved and it is mandatory to start with Shodhana Chikitsa as it purifies and normalize vitiated Doshas and Dhatus. Virechana Karma does Srotoshodhana by pacifying Pitta Dosha. Acharya Kashyapa tells Virechana is helpful in improving efficacy of Beeja.[9]

According to Acharyas, Basti is beneficial in Yonivyapads. It is considered as Ardha Chikitsa[10] thereby considered as superior than other therapeutic measures due to its various actions like Samshodhana, Samshamana, Sangrahana, Vajikarana, Bramhana, Karshana, Preenana and Vayasthapana.[11] Basti Karma is best choice of treatment for Vata Dosha and Vata associated with Pitta and Kapha. It exerts both systemic and local effects. Basti helps in correction of Apana Vata Karma and also helpful in correction of Jataragni and Dhatwagni Dushti leading to regulation of Rajah Pravritti and Bija Nirmana.

Sthanika Chikitsa in form of Uttara Basti has an important role in Garbhashaya and Yoni Shodhana. In this case, Uttara Basti done after complete cessation of menstruation will improve the blood circulation to the uterus and rejuvenates the endometrium for better implantation.

Conclusion

According to Taittiriya Aranyaka, acquiring eminent child is reputation as it liberates from the bonds of ancestors and importance is given to progeny as they are source of love, strength, happiness, professional excellence, fame etc. told by Acharya Charaka.[12]

Hence in Human life having progeny is like a wealth. In this case Shodhana Karma and Sthanika Chikitsa have played a vital role for the conception and uneventful pregnancy. The Ayurvedic treatment protocol for RPL is found to be very effective to procure healthy progeny and to maintain mother’s mental and physical health.


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Princy Prabhu et al. Ayurvedic management of Garbhasravi Vandhyatwa

References

1. Konar Hiralal. DC Dutta’s Textbook of Obstetrics, 16th Chapter, New Delhi, Jaypee Brothers Medical Publishers, 10th Ed:2023, Revised Reprint:2023, 160pp.

2. Konar Hiralal. DC Dutta’s Textbook of Obstetrics, 16th Chapter, New Delhi, Jaypee Brothers Medical Publishers, 10th Ed:2023, Revised Reprint:2023, 161-162pp.

3. Patil Vasant C. Sushruta Samhita, Nidana Sthana, New Delhi, Chaukhambha Publications, 8rd Ch, Vol 2, Ed: Reprint 2022:59pp.

4. Upadhyaya Yadunandana, Madhava Nidana with Madhukosha Sanskrit Commentary, 64/2, Varanasi, Chaukhambha Prakashan, ed: Reprint, 2009,431pp.

5. Kushwaha Harish Chandra Singh - Charaka Samhita, Chikitsa Sthana 30/28-29, Vol 2 Ayurveda Dipika Hindi Commentary. Varanasi Chaukambha Orientalia, Ed:2009: 803pp.

6. R Murthy Srikantha, Sushrutha Samhita, Varanasi, Chaukhamba Orientalia, Shareera Sthana 2/33, Vol-1, ed. 2004, 26pp.

7. Pandey Vaidya Jaymini, Harita Samhita with Nirmala Hindi Commentary, Trithiya Sthana 48/1-4, Varanasi, Chaukhambha Visvabharati, First ed:2010, 463pp.

8. Kushwaha Harish Chandra Singh - Charaka Samhita, Shareera Sthana 8/4, Vol-1, Ayurveda Dipika Hindi Commentary. Varanasi, Chaukambha Orientalia, Ed:2011: 853pp.

9. Pandit Hemaraj Sharma, Kashyapa Samhita, Vidyodhini Hindi Commentary, Chaukhambha Sanskrita Sansthana, Kalpa Sthana 6/33, reprint 2018, 390pp.

10. Vaghbhata Arunadatta, Hemadri, Astanga Hridaya, Basti Vidhi Adhyaya, 10th ed Varanasi Chaukhambha Orientalia 2011 vol 1, 286pp.

11. Sushrutha Dalhana Gayadasa Sushrutha Samhita Netra Basti Pramana Pravibhaga Chikitsa Adhyaya 1st ed, Varanasi, Chaukhambha Orientalia 2009 vol 1 pp525.

12. Kushwaha Harish Chandra Singh - Charaka Samhita, Chikitsa Sthana 2/1/21, Vol 2 Ayurveda Dipika Hindi Commentary. Varanasi, Chaukambha Orientalia, Ed:2009: 49pp.


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