GARBHA SRAVA & GARBHA PATA

GARBHA SRAVA AND GARBHA PATA – DEFINITION, NIDANA, SAMPRAPTI, LAKSHANA, AND CHIKITSA

GARBHA SRAVA

• Garbha Srava refers to the condition of abortion or miscarriage where the expelled foetus is immature and non-viable, and it generally occurs before the fetus becomes capable of independent survival.

• It is usually equivalent to spontaneous abortion in modern obstetrics.

शोणितस्य प्रवृत्तिः स्यात् गर्भिण्याश्चागमे भिषक्।
मासद्वयं नातिवर्तेत् स्रवो गर्भस्य निश्चितम्॥
(अष्टाङ्गहृदयम्, उत्तरतन्त्र, 1/44)

GARBHA PATA

• Garbha Pata refers to the forcible or unnatural expulsion of the fetus, often associated with trauma, external force, or deliberate actions (including attempts to abort the fetus).

• It can be equated to induced abortion or miscarriage due to trauma or toxins in modern medicine.

हतेऽथवा प्रपातः स्याद्बाह्याभिघातकारणात्।
गर्भपातो भवेदेषः सशूलः सानिलान्वितः॥
(सुष्रुतसंहिता, शारीरस्थान, 10/13)

NIDANA (ETIOLOGY)

AYURVEDIC NIDANA

• Ati Vyayama (Excessive exertion)

• Bhramana / Kampana (Travel or vibration)

• Vega Dharana (Suppression of natural urges)

• Abhighata (Trauma to the abdomen)

• Ashuchi Ahara (Unwholesome or contaminated diet)

• Rakta Dushti and Artava Dushti

• Beeja Dosha / Garbhashaya Dushti (Defective sperm, ovum, or uterus)

• Mental stress and grief

वातप्रकोपणं कर्म गर्भिण्या योऽनुपद्यते।
गर्भस्य पतनं तस्य कुरुते संप्रवर्तनम्॥
(चरकसंहिता, शारीरस्थान, 8/32)

MODERN CAUSES (ETIOLOGY)

• Chromosomal abnormalities (most common cause in 1st trimester)

• Infections (TORCH – Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex)

• Endocrine disorders (Hypothyroidism, uncontrolled diabetes)

• Anatomical defects (Septate uterus, fibroids)

• Placental abnormalities

• Trauma or exposure to harmful chemicals/radiation

• Immunological causes (e.g., Antiphospholipid antibody syndrome)

• Lifestyle factors – Smoking, alcohol, excessive caffeine, drug abuse

SAMPRAPTI (PATHOGENESIS)

AYURVEDIC VIEW

• The vitiation of Vata Dosha, especially Apana Vata, leads to Asrava (bleeding) and Utklesha (upward movement of vitiated doshas).

• This results in dhatukshaya, ksheena garbha dharana shakti, and finally, garbha avasthambhana vikriti leading to expulsion.

वातप्रकोपसम्भूता गर्भिणी यदि साधिता।
गर्भेण सह स रक्तं स्रवते तु प्रवर्तते॥
(अष्टाङ्गहृदयम्, उत्तरतन्त्र, 1/44)

MODERN PATHOGENESIS

• Implantation failure or defective placentation may result in abortion.

• Hormonal imbalances, especially progesterone deficiency, impair the endometrial receptivity and fetal support.

• Infections may directly affect the embryo or damage uteroplacental circulation.

• Vascular insufficiency leads to placental detachment and fetal demise.

LAKSHANA (CLINICAL FEATURES)

AYURVEDIC LAKSHANAS

• Per vaginal bleeding

• Lower abdominal or back pain (Katishoola or Udara Shoola)

• Mamsa-Pinda sadrisha srava (tissue-like discharge)

• Pralepa (sense of heaviness)

• Angasada, Bhrama, Panduta (fatigue, giddiness, pallor)

शोणितं स्रवते तस्य गर्भिण्या विबुधैरपि।
शूलं चोदरकटीस्थं भ्रंशो वा गर्भसङ्गिनः॥
(सुष्रुतसंहिता, शारीरस्थान, 10/14)

MODERN CLINICAL FEATURES

• Threatened abortion: Vaginal bleeding with closed cervical os, live fetus on USG

• Inevitable abortion: Bleeding with open cervical os, usually expulsion follows

• Incomplete abortion: Partial expulsion, retained products in uterus

• Complete abortion: Entire products of conception expelled

• Missed abortion: Fetal death with retained fetus

• Septic abortion: Infected retained products, fever, foul discharge

CHIKITSA (TREATMENT)

AYURVEDIC CHIKITSA

• In Threatened abortion (Garbha Sthapana):

  • Snehana (Oleation) and Mridu Swedana (Mild fomentation)

  • Use of Garbha Sthapaka Yogas:

    • Phala Ghrita

    • Ashoka, Lodhra, Musta, and Shatavari preparations

    • Yastimadhu ksheera paka

  • Rest and avoidance of exertion

  • Cool, nutritious, Madhura Rasa dominated diet

गर्भिण्यास्तु विशेषेण रक्षणं गर्भधारणे।
दोषाणामवसेकं च तत्र तद्विधिना भवेत्॥
(अष्टाङ्गहृदयम्, उत्तरतन्त्र, 2/25)

• In Complete/Incomplete Abortion (Garbha Pata):

  • Shodhana only after assessment of strength (usually avoided unless required)

  • Use of Rakta Sthambhaka Dravyas – Lodhra, Nagakesara, Vata

  • Post-abortion recovery with Rasayana therapy – Ashwagandha, Shatavari

  • Psychological support (Satvavajaya Chikitsa)

MODERN MANAGEMENT

• Threatened abortion: Bed rest, progesterone support, monitoring

• Inevitable/Incomplete abortion:

  • Medical management: Misoprostol, Mifepristone

  • Surgical evacuation: MVA (Manual Vacuum Aspiration), D&C

• Septic abortion: IV antibiotics, evacuation, supportive care

• Missed abortion: Expectant, medical, or surgical evacuation depending on gestational age and patient’s condition

• Follow-up care: Rh immunoglobulin if Rh negative, iron-folate supplements, emotional counselling

PREVENTION

AYURVEDIC PREVENTIVE MEASURES

• Preconceptional care: Beejashuddhi, Garbhashaya Shuddhi

• Adoption of Garbhini Paricharya

• Avoidance of Vata aggravating factors

• Use of Phala Ghrita and Rasayana before and during early pregnancy

MODERN PREVENTION

• Antenatal screening for infections, diabetes, thyroid

• Correction of anatomical or hormonal disorders before conception

• Avoiding known teratogens

• Genetic counselling for recurrent pregnancy loss