Age – 18 Yrs
Sex – Female
Date – 04/12/2011
She came with a history of 33 weeks ANC primigravida.
LMP – 04/02/2010
Her EDD was – 07/01/12.
USG – Obstetrics ( 03/12/2011)
Amniotic Fluid Index (AFI) 5.3, ( Normal is 8-18 )
The rest was normal
O/E – Fetal movement normal
No edema over feet / face.
Appetite – Normal
Desires – Salty, Sour, Apples
Aversion – Sweet, Milk
Perspiration – Face
Sleep – Normal
Dreams – Unremembered
Past History – Typhoid
Thermals – Hot
Mental Generals –
Anger – indisposed to talk
Cannot express herself.
Remedy –Lycopodium 200 2 doses stat.
Advised to take protein rich diet and plenty of water.
09/12/2011:- REVIEW USG OBSTETRICS (08/12/2011)
AFI – 10.8
Remedy – S.L
28/12/2011:- USG Obstetrics (19/12/2011)
AFI – 11.6
Remedy – Carcinocin 200 2 doses. (Anti – miasmatic).
05/01/2012: Full term ANC.
Fetal Movements Normal
Lumbar pain since 2 days.
Remedy –Caulophyllum 30 TDS
Follow up with Obstetrician for further assessment and management.
Patient underwent FTND on 15/01/2012 and delivered a healthy female baby.
USG KUB of Baby: ( 16/01/2012 )
Impression – Normal Study
Scanned copies of all USG Reports are attached below serially
USG After 5 days of treatment
USG After 15 days of treatment
Comments: - This was a case of 33 weeks ANC and all other modern faculty doctors were insisting on the patient having elective induction of labor and SOS LSCS delivery as her AFI was 5.3. However homoeopathy had the ability to increase AFI as early as possible. 2 doses of Lycopodium were given at intervals of one hour.
Follow up intercurrent was anti miasmatic: Carcinocin 200 2 doses. It was given for removal of any miasmatic blocks in the baby.
After delivery USG of Baby was done to confirm for any congenital Anomaly in the baby.
Oligohydramnios and Homoeopathy
Definition:-Oligohydramnios is a condition in which there is not enough amniotic fluid surrounding and cushioning the baby. It usually develops in the latter part of the third trimester.
Incidence:-About 8 percent of pregnant women will experience low amniotic fluid levels, although only 4 percent will be diagnosed with Oligohydramnios. Women are at increased risk for the condition if they go past their due date as amniotic fluid levels decrease by nearly 50 percent after week 42. It causes complications in 12 percent of pregnant women past week 41
Amniotic fluid:-Amniotic fluid is to be found in the amniotic cavity. It completely surrounds the embryo after the 4th week of pregnancy. The amniotic fluid is a clear, watery fluid that is filtered out of the maternal blood via the amniotic epithelium into the amniotic cavity. The makeup of the amniotic fluid is thus quite complex, with many maternal and fetal constituents. The main constituents are water and electrolytes (99%) together with glucose, lipids from the fetal lungs, proteins with bactericide properties and flaked-off fetal epithelium cells.
Amniotic fluid physiology:-Adequate amniotic fluid volume is maintained by a balance of fetal fluid production (lung liquid and urine) and resorption (swallowing and intramembranous flow). Even though different hypotheses have been advanced on the mechanisms regulating this turnover, the inflow and outflow mechanism that keeps amniotic fluid volume within the normal range is not entirely clear. Regulatory mechanisms act at three levels: placental control of water and solute transfer; regulation of inflows and outflows from the fetus; and, maternal effect on fetal fluid balance. Amniotic fluid is 98-99% water.
About 4 liters of water accumulate within intrauterine compartments during the 40-week period of human gestation, with 2800 ml in the fetus, 400 ml in the placenta, and 800 ml in the amniotic fluid. At the beginning of pregnancy, amniotic fluid volume (AFV) is a multiple of fetal volume. The two volumes become equal soon after the 20th week, but by the 30th week AVF is about half the fetal volume and at term it is about a quarter of fetal volume. In the last trimester, near term, there are net increases of about 30 to 40 ml per day.
Regulatory mechanisms act at three levels:
– Placental control of water and solute transfer.
– Regulation of inflows and outflows from the fetus: fetal urine flow and composition are modulated by arginine, vasopressin, aldosterone, angiotensin II, and atrial natriuretic peptide, in much the same way as they in adults. The mechanisms regulating fetal swallowing are less known.
– Maternal effect on fetal fluid balance: there is a strong relationship between maternal plasma volume expansion during pregnancy and AVF, so that subnormal plasma volume expansion is associated with Oligohydramnios and elevated plasma volume with hydramnios. Kilpatrick et al. (11) reported that ingestion of 2 liters of water in women with a low amniotic fluid index (AFI) resulted in a significant 31% AFI increase.
Causes of Oligohydramnios:-
Ruptures:-A slight tear or rupture in the amniotic sac can cause a gush of fluid or a slow trickle. Premature rupture of the membranes (PROM), where the sac breaks after week 37 but before labor starts, can also result in low amniotic fluid levels.
Mothers Health:-If the mother develops health complications during pregnancy, such as gestational diabetes, pregnancy induced hypertension, Intra-uterine infection and preeclampsia; these can all be possible factors. Any pre-pregnancy conditions, such as diabetes can also be a cause. This is why, when preparing for pregnancy, any existing health concerns are addressed and properly managed.
Medications:-Certain medications, such as those used in the treatment of high blood pressure, can cause Oligohydramnios. Ideally it would be better to work with your doctor to ensure that blood pressure in under control before becoming pregnant.
Placental Issues:-If the placenta is not functioning correctly, the baby is not supplied with enough nutrients and it may stop recycling fluid. A slight placental abruption, where the placenta peels away from the uterus could cause this to happen.
Birth Defects:-Birth defects which cause problems with the baby’s kidneys or urinary tract can lead to a reduction in urine production. Fetus urine is important for keeping amniotic fluid at the correct level.
Over-Due:- If the pregnancy goes 2 weeks or more past its due date, amniotic fluid levels can sharply decline.
If it happens in the first 2 trimesters it can result in:
1. Miscarriage: Baby dies in the womb before week 20.
2. Stillbirth: Baby dies in the womb after week 20.
3. Premature Birth: Premature labor happens before the baby has completed week 37 of development.
4. Birth Defects: Primarily kidney or urinary tract problems. It can also cause compression of other organs so that they do not develop properly.
If it happens in the third trimester it can result in:
1. The fetus to grow at a slower rate: Intrauterine growth restriction.
2. Umbilical cord restrictions: If it is squeezed this means the baby does not receive enough nutrients or oxygen. It can result in decreased fetal activity and in some cases the heart rate can drop.
3. Delivery: Greater chance that a C-section delivery will be necessary.
The earlier in pregnancy that Oligohydramnios occurs, the poorer the outlook. Fetal mortality rates have been reported as high as 80 to 90 percent when Oligohydramnios happens in the second trimester of pregnancy. Most deaths are the result of severe birth defects (congenital malformations). The prognosis for cases in the third trimester is very positive and most mothers, whose cases are properly managed, go on to deliver healthy normal babies.
Homoeopathic management:- It depends on the cause of diseases. Homoeopathic constitutional remedy act centrally on human vital system and make changes in the osmotic pressure by reducing maternal plasma osmolality and sodium concentration, resulting in an osmotically driven maternal to fetal water flux. Increased placental blood flow volume, fetal urine output, and possibly decreased reabsorption of amniotic fluid via swallowing or intramembranous flow increases the amniotic fluid volume
Intrauterine Growth retardation -Refer to Obstetrician for further assessment and management
Posterior urethral valves or bilateral pelviurethral junction obstruction -Refer to Obstetrician for further assessment and management
Fetal polycystic kidney diseases / Multicystic dysplastic kidney disease -Start Homoeopathic treatment under supervision of Obstetrician if no any other congenital anomaly detected by ultrasonographically.
No cause detected -Start Homoeopathic treatment under supervision of Obstetrician.
Monitoring of fetal movements and fetal heart beat is very important in treating a patient of Oligohydramnios.
Follow up –
Review after 1 week – Improvement – Continue treatment.
No Improvement – Refer to Obstetrician for further assessment and management.