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
Alka: Ayurvedic Management of Premature Uterine Contraction
AAMJ / Vol. 4 / Issue 1 / Jan– Feb 2018 1674
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.
ΛΛΛΛ
Alka: Ayurvedic Management of Premature Uterine Contraction
AAMJ / Vol. 4 / Issue 1 / Jan– Feb 2018 1675
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6, ISBN10: 81-8147-847-6.
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gotreeyam shareeram, 2/6, Chaukambha Bharati Acad-
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tralaya; 1947. Uttarardha paribhasha khanda. 33-34.
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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.
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