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Chapter 64 – Mudhagarbha Nidanam

The 64th chapter of Madhava Nidana is Mudhagarbha Nidana which deals with Abnormal Pregnancy.

Definition

Aetiology and Prodromal Features of Miscarriage

भयाभिघातात्तीक्ष्णोष्णपानाशना निषेवणात् |
गर्भे पतति रक्तस्य सशूलं दर्शनं भवेत् || १ ||

bhayābhighātāttīkṣṇōṣṇapānāśanā niṣēvaṇāt |
garbhē patati raktasya saśūlaṁ darśanaṁ bhavēt || 1 ||

The following factors lead the pregnant to abort the embryo from inside the uterus, along with pain and heavy bleeding:

  • Sudden fear
  • Injury,
  • Ingestion of eatables and drinks that produce tremendous heat. 1

Abortion and Miscarriage

आचतुर्थात्ततो मासात् प्रस्रवेद् गर्भविद्रवः |
ततः स्थिरशरीरस्य पातः पञ्चम – षष्टयोः || २ ||

ācaturthāttatō māsāt prasravēd garbhavidravaḥ |
tataḥ sthiraśarīrasya pātaḥ pañcama – ṣaṣṭayōḥ || 2 ||

Upto the fourth month of conception, the abortive material is discharged from womb in a liquid form only and, hence, the case is known as Abortion (garbhasraava); and if the womb is emptied in fifth or sixth month of conception (i.e., when the embryo has developed harder parts), it is known as Miscarriage (garbhpaata). 2

Precipitating factors of abortion

गर्भो अभिघात – विषमाशन – पीडनाध्यैः
पक्वं द्रुमादिव फलं पतति क्षणेन |   

garbhō abhighāta – viṣamāśana – pīḍanādhyaiḥ
pakvaṁ drumādiva phalaṁ patati kṣaṇēna |

Garbhapata takes place just a ripe fruit falls from a tree by trauma on the stomach, unhealthy eating practices, unnecessary massage or pressure on stomach.

Clinical features of obstructed labour

मूढः करोति पवनः खलु मूढगर्भ
शूलं च योनि – जठरादिषु मूत्रसङ्गम् || ३ ||

mūḍhaḥ karōti pavanaḥ khalu mūḍhagarbha
śūlaṁ ca yōni – jaṭharādiṣu mūtrasaṅgam || 3 ||

The vitiated vata causes difficulty in delivery along with pain in the uterine passages and stomach and blockage to urination. 3

Abnormal fetal presentation

भुग्नो अनिलेन विगुणेन ततः स गर्भः सङ्ख्यामतीत्य बहुधा समुपैति योनिम् |
द्वारं निरुद्ध्य शिरसा जठरेण कश्चित् कश्चिच्छरीरपरिवर्तितकुब्जदेहः || ४ ||
एकेन कश्चिदपरस्तु भुजद्वयेन तिर्यग्गतो भवति कश्चिदवाङ्गमुखो अन्यः |
पर्श्वापवृत्तगतिरेति तथैव कश्चिदित्यष्टधा गतिरियं ह्यपरा चतुर्धा || ५ ||

bhugnō anilēna viguṇēna tataḥ sa garbhaḥ saṅkhyāmatītya bahudhā samupaiti yōnim |
dvāraṁ niruddhya śirasā jaṭharēṇa kaścit kaściccharīraparivartitakubjadēhaḥ || 4 ||
ēkēna kaścidaparastu bhujadvayēna tiryaggatō bhavati kaścidavāṅgamukhō anyaḥ |
parśvāpavr̥ttagatirēti tathaiva kaścidityaṣṭadhā gatiriyaṁ hyaparā caturdhā || 5 ||

Due to vitiated vata the fetus often presents in innumerable ways in a crooked position in the birth canal (as follows) : When vata is increased, it creates several kinds of abnormal presentations of the fetus inside the vagina. Major among such presentation are the eight positions as following:

  • blockage of the mouth of the uterus by the face of the fetus,
  • blockage of the mouth of the uterus by the stomach of the fetus,
  • blockage of the mouth of the uterus by the back of the fetus curved and shortened,
  • blockage of the uterus by one shoulder of the fetus.
  • blockage of the mouth of the uterus by both the shoulders.
  • Blockage of the uterus by the body of the fetus in transverse position,
  • Blockage of the uterus by the face of the fetus bent down,
  • blockage of the mouth of the uterus by the flanks of  the fetus.

These are eight abnormal fetal presentations. Still, there are four other problematic fetal presentations; they have been described below. 4-5

Four other presentations

संकीलकः प्रतिखुरः परिघो अथ बीजस्तेषूर्ध्वबाहुचरणैः शिरसा च योनिम् |
सङ्गी च यो भवति कीलकवत् स कोलो दृश्यैः खुरैः प्रतिखुरं स हि कायसङ्गी |
गच्छेद्भुजद्वय – शिराः स च बीजकाख्यो योनौ स्थितः स परिघः परिघेण तुल्यः || ६ ||

saṅkīlakaḥ pratikhuraḥ parighō atha bījastēṣūrdhvabāhucaraṇaiḥ śirasā ca yōnim |
saṅgī ca yō bhavati kīlakavat sa kōlō dr̥śyaiḥ khuraiḥ pratikhuraṁ sa hi kāyasaṅgī |
gacchēdbhujadvaya – śirāḥ sa ca bījakākhyō yōnau sthitaḥ sa parighaḥ parighēṇa tulyaḥ || 6 ||

Kilaka, Pratikhura, parigha and bijadosha are the four other presentations.

The mouth of the uterus is blocked by the raised hand or feet of the fetus in cases. This condition is known as Kilaka; bending of the body of the fetus like a horse’s hoof with both of its hands and feet coming closer in front, obstructing the uterus is a condition that has been identified as Pratikhura; the two shoulders and head of the fetus obstructing is Bijaka. Finally, there is a condition known as Parigha, in which the fetus remains in transverse position like the bolt of a door inside the uterus. 6

अपविद्धशिरा या तु शीताङ्गी निरपत्रपा |
निलोद्गतसिरा हन्ति स गर्भं स च तां तथा || ७ ||

apaviddhaśirā yā tu śītāṅgī nirapatrapā |
nilōdgatasirā hanti sa garbhaṁ sa ca tāṁ tathā || 7 ||

The features that can prove fatal to the expectant mother and to her child include the following:

  • One who is unable to hold her head upright,
  • whose body has turned cold,
  • who has lost her natural shyness (nirapatrapa), and
  • who has developed prominent and blue colour veins on the stomach. 7

Intrauterine Fetal death

गर्भास्पन्दनमावीनां प्रणाशः श्याव – पाण्डुता |
भवेदुच्छ्वासपूतित्वं शूनता अन्तर्मृते शिशौ || ८ ||

garbhāspandanamāvīnāṁ praṇāśaḥ śyāva – pāṇḍutā |
bhavēducchvāsapūtitvaṁ śūnatā antarmr̥tē śiśau || 8 ||

Features of the woman whose fetus has turned dead inside include the following:

  • Absence of fetal movements as well as labour pain,
  • body of mother turning blue or yellowish white,
  • appearance of bad smell in her breath and
  • an abnormally large stomach. 8

Causes of intrauterine fetal death

मनसागन्तुभिर्मातुरूपतापैः प्रपीडितः |
गर्भो व्यापध्यते कुक्षौ व्याधिभिश्च निपीडितः || ९ ||

manasāgantubhirmāturūpatāpaiḥ prapīḍitaḥ |
garbhō vyāpadhyatē kukṣau vyādhibhiśca nipīḍitaḥ || 9 ||

The fetus may die within the uterus due to mental disorders, external injury, and excessive physical strain for the mother and as an effect of several diseases. 9

Complications

योनिसंवरणं सङ्घः कुक्षौ मक्कल्ल एव च |
हन्युः स्त्रियं मूढगर्भां यथोक्ताश्चाप्युपद्रवाः || १० ||

yōnisanvaraṇaṁ saṅghaḥ kukṣau makkalla ēva ca |
hanyuḥ striyaṁ mūḍhagarbhāṁ yathōktāścāpyupadravāḥ || 10 ||

Implications of the mudhagarbha that is going to kill the woman include the following:

  • Total blockage of the uterus (yonisamvarana)
  • Dead fetus staying in the uterus for long time (kukshi sanga)
  • And pain after delivery (makkalla). 10

Makkalla

वायुः प्रकुपितः कुर्यात् संरुध्य रुधिरं स्रुतम् |
सूताया ह्रुच्छिरो – बस्तिशूलं मक्कल्ल संज्ञकं || ११ ||

vāyuḥ prakupitaḥ kuryāt sanrudhya rudhiraṁ srutam |
sūtāyā hrucchirō – bastiśūlaṁ makkalla sañjñakaṁ || 11 ||

The gynecological disease caused due to morbid increase in vaata, associated with the blockage to the discharge of uterine fluid after delivery along with pain in the region of the heart, head and urinary bladder has been identified as Makkalla.

इति श्री माधवकरविरचिते माधवनिदाने मूढगर्भनिदानं समाप्तम् || ६४ ||

iti śrī mādhavakaraviracitē mādhavanidānē mūḍhagarbhanidānaṁ samāptam || 64 ||

Thus concludes the chapter on Moodhagarbha.