A CLINICAL STUDY FOR THE EVALUATION OF THE EFFECT OF BALA MOOLA CHURNA IN ASRIGDARA

Menstruation is a physiological function that denotes a healthy reproductive system in a woman. A normal menstrual cycle is vital for every woman's physical and psychological well-being. Asrigdara is a condition where there is excessive or prolonged bleeding. Considering the symptoms, it can be related to Dysfunctional Uterine Bleeding, a state of abnormal bleeding without any clinically detectable organic, systemic or iatrogenic causes. It is common in multiparous women than in nulliparous women. Bala Moola mentioned in Chakradutta is undertaken for the present study to evaluate its efficacy in Asrigdara. A randomized clinical study consisting of two groups, with 20 patients in each group were selected. Group A was given trial drug Bala Moola Churna with milk and honey in the dose of 6 gms twice daily after food for three consecutive cycles. Group B was given Tranexamic acid one tablet twice after food for three-cycle. Both the drugs were given till the bleeding stopped or a maximum of 15 days. The study showed that both the drugs, Bala Moola Churna and Tranexamic acid, were equally effective in reducing the symptoms of Asrigdara at the end of treatment.

A study of feto maternal outcome in primary caesarean section

Background: Primary caesarean section is defined as caesarean section to be performed in women who have not had previous caesarean delivery. The increase in the rates of primary caesarean section is not only due to increased caesarean section in nulligravida but also due to upward rise in caesarean section rates in parous women. Through this study we aimed to examine the frequency and the indications of primary caesarean section in nulliparous and multiparous women.Methods: A prospective study was carried out in the OBGY department of smt. SCL Hospital, NHL municipal medical college from April 2020 to April 2021. All multiparous women with previous normal vaginal delivery who underwent caesarean section this time were included in this study. Patients with previous caesarean section <28 weeks of gestation, patients who did not give consent were excluded from the study.Results: 92% were 20-30 years and are gravida 2 or 3 patients. 85% patients were booked patients. Most common indication of primary caesarean section in parous women was MSL+FD (31%). Difficulty in delivery of the baby was encountered in 45% of cases. Major cause of admission in NICU was MAS.Conclusions: Primary caesarean section has become a major driver of overall caesarean section rate. Decision making on primary caesarean section should be carefully scrutinized, introducing a diagnostic second opinion for all primary caesarean section. Primary caesarean section in both multigravida and primigravida becomes mandatory in many cases to prevent maternal and feta morbidity.

Non-invasive Resolution of Pathological Ovarian Masses with Homeopathic Treatment—A Case Series

Background Ovarian masses may be either physiological or pathological. Physiological ovarian masses are non-neoplastic. Pathological masses grow more than 7 cm and persist beyond 3 months; they do not resolve spontaneously, and invasive surgery with removal of reproductive organs is the conventional treatment. It usually results in further co-morbidities and hampers the quality of life of the patient. Objectives This case series of pathological left ovarian masses demonstrates the role of homeopathic treatment in each of two multiparous women where the right ovary was surgically removed previously for similar pathology and in an adolescent girl with increased tumor marker CA-125. Methods Three cases of women with pathological ovarian masses in the left ovary, and advised invasive surgery by attending gynecologists, were treated with homeopathic medicines at the outpatient department of the National Homeopathy Research Institute in Mental Health, Kottayam, Kerala, from 2017 to 2020. Each case was followed up with clinical and ultrasonographic evidence and reported according to the criteria set out in the HOM-CASE guidelines. Result Complete resolution of the ovarian masses was observed in all three cases, evidenced by ultrasonography, with normalizing CA-125 values also observed in the case of endometrial cyst. The patients improved within 4 to 15 months of treatment using Thuja and other individualized homeopathic medicines. The MONARCH score was calculated as +7/13, +9/13, and +9/13 for the three cases, respectively, indicating a positive causal attribution of homeopathy in the resolution of these pathological ovarian masses. Conclusion This case series suggests that individualized homeopathy, and notably Thuja, can be useful in the treatment of pathological ovarian masses.

UTERUS DIDELPHYS IN NULLIPAROUS AND MULTIPAROUS WOMEN – A RARE ENTITY

Uterus didelphys is a rare congenital uterine abnormality in which the embryogenetic fusion of the Mullerian ducts fails to occur. It will lead to the formation of a double uterus with two separate cervices and most often a double vagina with a longitudinal septum as well. Here, we present two different cases of uterus didelphys with varied presentations. The first case is a nulliparous woman presented with post-coital bleeding. On examination, two cervical openings with a longitudinal complete vaginal septum were found, conservative management was done. Findings of didelphys uterus were confirmed on USG. The patient was counseled and discharged. The second case is a multiparous woman with previous cesarean delivery, rupture of membranes, and meconium in this pregnancy with term pregnancy taken up for emergency cesarean section. Dense adhesions and a mass on the right side of uterus were found intraoperatively, which on further inspection confirmed to be patent right horn of uterus. Diagnosis of uterus didelphys was made after doing per speculum and per vaginal examination post-cesarean.

Preeclampsia—an immune disease? An epidemiologic narrative

The maternal syndrome preeclampsia is triggered by syncytiotrophoblast (STB) stress; the heterogeneity of the syndrome is caused by the different pathways leading to this STB stress. Inflammation plays a pivotal role in the pathogenesis of preeclampsia. While, the immune system at large is therefore intimately involved in the causation of this heterogeneous syndrome, the role of the adaptive immune system is more controversial. The classic paradigm placed preeclampsia as the disease of the nulliparous pregnant women. Up to the later part of the 20th century, human reproduction, particularly in Western societies, was characterised by a low rate of pre-marital sex, and the great majority of children being born within one stable sexual relationship. More prolonged periods of regular sexual intercourse within a stable relationship have been demonstrated to reduce the risk of preeclampsia and fetal growth restriction. Primarily animal studies have indeed shown that repetitive sperm exposure leads to partner specific mucosal tolerance. Societal changes made partner change over the reproductive period of individual women extremely common. For the adaptive immune system of multiparous women, being pregnant in a new sexual relationship (primipaternity) would represent being faced with a new “hemi-allograft”. In these pregnancies, potential couple-specific immune “maladaptation” could lead to the superficial cytotrophoblast invasion of the spiral arteries, known to be associated with early-onset preeclampsia. Having a new pregnancy in a different relationship does indeed increase the risk for this type of preeclampsia. Large epidemiologic population studies identified prolonged birth interval but not “primipaternity” as a risk factor for preeclampsia in multiparous women. This apparent contradiction is explained by the fact that the great majority of preeclampsia cases in these population studies involve term preeclampsia. In late-onset preeclampsia, the far more common phenotype of the syndrome, STB stress is not caused by lack of proper spiral artery modification, but involves maternal genetic predisposition to cardiovascular and metabolic disease, with in particular obesity/metabolic syndrome representing major players. Partner or couple specific issues are not detectable in this disease phenotype.