Critical Review of Vandhyatwa w.s.r. Anovulation - Literary review

Infertility is a condition which can be defined as inability to conceive with minimum one year of unprotected sexual life. There may be good number of reasons for this condition to cause. Inability of couples to fulfill their desire of continuing the family has been a social stigma since ages. Due to increasing publicity and awareness and also educational status of couple making them easy to seek help for the conception. The causes for this condition are problems in female and male reproductive system in structure and physiological function, psychology of couple, genetic, environmental, immunological and sometime unexplained causes also may account for this condition. Vandyatwa is a condition where a female fails to conceive and also unable to continue pregnancy and give a birth of a live baby and also unable to conceive in future. Ayurveda believes that the conception occurs only in Shudha Yoni. Methodology: To review, analyse and interpret about female Infertility, its types, causes, Anovulation as one of the causes of infertility, its types, interpretation and Ayurvedic understanding of anovulation as a cause of Vandyatwa. The integral part of achieving Sreyasi Praja are Garbhasambhava Samagri which includes Ritu, Kshetra, Ambu, Beeja. As there are many causes for Vandyatwa mentioned, in this study Vandyatwa due to Arthava Nasha or Nastartva is considered where Arthava is taken as ovum. Discussion- Infertility is observed in approximately 10-15% of couples of reproductive age. Ovulation disorders account for about 30-40% of female infertility and about 20% of infertility couple. Anovulation is caused due to the defect in the function of hypothalamus -pituitary- ovarian axis. Arthava is considered as ovum and it is formed as a Upadhatu after the proper digestion of Ahara Rasa by Prakrutha Agni. If Agni is disturbed by Ahita Ahara vihara formation of Rasadi Dhatu there by Arthava is also affected causing Nastartva which can be considered as anovulation. The condition Nastartva also can be managed by Deepana pachana and Arthava Janaka which is the line of management to correct the Samprapti and to restore fertility. Many Yogas are mentioned by our Acharya’s, & Pipplayadi Yoga which contains Trikatu and Nagakeshara is one among them mentioned in Bhaishajya Ratnavali Yonivyapath chikitsa for Vandyatwa.

A rare case of vaginal sarcoma in pregnancy

Vaginal Sarcoma is an extremely rare tumour in pregnancy. Authors are presenting a case report of a pregnant woman who presented with vaginal mass and urinary retention at 32 weeks of gestational age. USG confirmed a live baby with possibility of cervical fibroid. Before further investigations for diagnosis of the mass her emergency LSCS has to be done. Histopathology and immunohistochemistry then confirmed sarcoma.

Delivering a female with missing cervix: a case report

Authors received a case in our casualty, 26 years old, G2P1L1, with full term pregnancy, spontaneous conception, previous normal vaginal delivery, with labour pain. On evaluation, she was having uterine contraction, fetal heart rate normal, vitally stable, with no cervix on per speculum and per vaginal examination, with solid globular mass per rectum. She was shifted to emergency operation theatre with provisional diagnosis of uterine rupture or rectal perforation or pelvic mass. After delivering a live baby, uterus was intact, but there was an impacted mass in pouch of Douglas, it was a twisted ovarian mass, sent for histopathology examination. Post-operative period was uneventful, and patient was discharged with healthy baby with corrected pelvic anatomy.

Successful Pregnancy after Previous Uterine Rupture

Uterine rupture is a rare and catastrophic incidence with high maternal and fetal morbidity rates. It is most commonly seen in the scarred uterus. The unscarred uterus is least susceptible to rupture with the incidencebeing 1 in 8000 deliveries. In the past, pregnancy after uterine rupture was not widely advised and patients underwent hysterectomy or tubal ligation but with the evolving practice, women are motivated for pregnancy which can be successful with proper obstetric care and emphasis on time and mode of delivery. Here we present a case of 31 years old female, gravida-2 para-1 living 0 with previous uterine rupture after medical induction of labor with stillbirth 4 years ago. She underwent emergency laparotomy with the repair. The patient spontaneously conceived and had close antenatal care throughout the pregnancy. The patient was admitted at 34 weeks of gestation and kept under close surveillance. Corticosteroid was administered. She underwent spontaneous labor at 37 weeks of gestation and emergency cesarean section was planned, delivered via a breech presentation to a live baby of 2.4 kg, APGAR score of 8/10, 9/10 at 1 and 5 minutes.

A rare case of fetus papyraceous presenting in monozygotic biamniotic twins

Fetus papyraceous or compresses is characteristic of compressed mummified, parchment like remains of dead twin retained in utero after intrauterine death in the second trimester. It is an uncommon finding and we report in a G2P1L1 with 22 weeks with Monozygoticbiamniotic twins with fetus papyraceous stuck to left upper segment followed up to 36 weeks. The mother was advised regular antenatal visits and frequent feto-maternal monitoring was done. Patient delivered a single live baby and a placenta with mummified fetus within it. The incidence of fetus papyraceous is about 1 in 17000 to 1 in 20000 pregnancies. Early diagnosis of this condition helps in monitoring the surviving fetus.

Osteogenesis imperfecta and pregnancy: a case report

Background Osteogenesis imperfecta is a rare connective tissue disorder of varying phenotypic presentations. In pregnancies complicated by osteogenesis imperfecta, there is an increased risk to both the mother and fetus. Case presentation We present a case of a 34-year-old, wheelchair-bound, primigravid African (Zimbabwean) patient with short stature and skeletal deformities. Her care, requiring a multidisciplinary team approach, resulted in the delivery of a live baby girl with a birth weight of 2100 g, also with osteogenesis imperfecta. Conclusion Good outcomes are reported when a multidisciplinary team is involved in the care of patients with osteogenesis imperfecta. Pregnancies can be carried to term but require close antenatal surveillance. Prenatal diagnosis is possible with ultrasound and genetic testing. Delivery should be carefully planned by a multidisciplinary team. Decisions on delivery mode should be made on a case-by-case basis.

Sirenomelia, the mermaid baby: a case report

Sirenomelia sequence or mermaid syndrome is a rare congenital structural anomaly characterized by different degrees of fusion of lower limbs, thoracolumbar spinal anomalies, sacrococcygeal agenesis, genitourinary and anorectal atresia. The incidence of sirenomelia is 0.8-1 cases/ 105 births with male to female ratio being 3:1. A malformations patient with 40 weeks of gestation admitted with complaints of decreased fetal movements for one week. An emergency C-section was done in view of term pregnancy with severe oligohydramnios and intrauterine growth restriction with poor bishop’s score. A 1.9 kg live baby with fused lower limbs was delivered. The new born baby had narrow chest, fused both lower limbs and feet with 11 toes, small rudimentary external genitalia, imperforate anus and single umbilical artery. The baby also had features of potter’s facies including low set large ears, receding chin and prominent infraorbital folds. Sirenomelia is a rare fatal congenital anomaly. Early detection by prenatal ultrasound will help in timely termination of pregnancy.

Undiagnosed Abdominal Term Pregnancy with Good Neonatal Outcome

Abdominal pregnancy is a rare occurrence and it represents only 1% of ectopic pregnancy. We report a case of an abdominal pregnancy that resulted in a term live baby. Diagnosis is unsurprisingly difficult in advanced gestation. A high index of suspicion detailed clinical and imaging examinations are needed to make the diagnosis. Multidisciplinary team involvement is crucial in the management of abdominal pregnancy.