Changes

*Advice given to the pregnant woman.

*Advice given to the pregnant woman.

The supervision should be regular and periodic in nature according to the need of the individual.

The supervision should be regular and periodic in nature according to the need of the individual.<ref> D.C Dutta, D.C.Dutta’s Text book of Obstetrics, edited by HiralalKonar, Jaypee brothers medical publishers, New Delhi, edition 8,Chapter 10 , page no:106.</ref>

The aims and objectives of the antenatal care include the screening of high-risk cases, continuing the risk assessment and preventing/detecting the complications at the earliest stage to ensure a normal pregnancy with delivery of a healthy baby from a healthy mother.

The aims and objectives of the antenatal care include the screening of high-risk cases, continuing the risk assessment and preventing/detecting the complications at the earliest stage to ensure a normal pregnancy with delivery of a healthy baby from a healthy mother.

This model guides pregnant woman about frequency and time of contact for consultation of an obstetrician.

This model guides pregnant woman about frequency and time of contact for consultation of an obstetrician.

'''Table 3: Antenatal care model by WHO (2016)'''  

'''Table 3: Antenatal care model by WHO (2016)'''<ref>https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/ </ref>

{| class="wikitable"

{| class="wikitable"

|-

|-

'''Calculation of the expected date of delivery:'''

'''Calculation of the expected date of delivery:'''

This is done according to Naegele’s formula by adding 9 calendar months and 7 days to the first day of LNMP.  

This is done according to Naegele’s formula by adding 9 calendar months and 7 days to the first day of LNMP.<ref>D.C Dutta,D.C Dutta’s text book of obstetrics, edited by HiralalKonar, Antenatal care ,preconceptional counseling and care, Jaypee brothers medical publishers, New delhi, edition 8, 2015, chapter 10, page no:108.</ref>

Examination includes general physical examination, systemic examination and obstetrical examination.

Examination includes general physical examination, systemic examination and obstetrical examination.

Height of the uterus is measured by placing the ulnar border of the left hand placed on the upper most level of fundus and an approximate duration of pregnancy is ascertained in terms of weeks of gestation. Alternatively, the symphyseal fundal height (SFH) is measured with a measuring tape.

Height of the uterus is measured by placing the ulnar border of the left hand placed on the upper most level of fundus and an approximate duration of pregnancy is ascertained in terms of weeks of gestation. Alternatively, the symphyseal fundal height (SFH) is measured with a measuring tape.

Obstetrical grips (Leopold maneuvers) are helpful to get an idea about the presentation of foetus, position of different body parts of foetus, attitude, engagement etc.

Obstetrical grips (Leopold maneuvers)<ref>D.C Dutta, D.C Dutta’s text book of obstetrics, The Fetus- in utero, Jaypee brothers medical publishers, Newdelhi, edition 8, 2015, chapter 8, page no:88-90. are helpful to get an idea about the presentation of foetus, position of different body parts of foetus, attitude, engagement etc.</ref>

'''c) Auscultation:'''

'''c) Auscultation:'''

'''Genetic Screening:'''  

'''Genetic Screening:'''  

This includes maternal serum alpha-fetoprotein (MSAFP), triple test at 15-18 weeks for mother at risk of carrying a fetus with neural tube defects, down syndrome or other chromosomal anomaly. Non-invasive screening for chromosomal anomaly should be a routine to all pregnant women irrespective of their age.  

This includes maternal serum alpha-fetoprotein (MSAFP), triple test at 15-18 weeks for mother at risk of carrying a fetus with neural tube defects, down syndrome or other chromosomal anomaly. Non-invasive screening for chromosomal anomaly should be a routine to all pregnant women irrespective of their age.<ref>D.C Dutta, D.C.Dutta’s Text book of Obstetrics, edited by HiralalKonar, Jaypee brothers medical publishers, New Delhi, edition 8,Chapter 12 , page no:127</ref>

*'''Ultrasound Examinations :'''

*'''Ultrasound Examinations :'''

All the information of second trimester sonography can be obtained in third trimester. Effective fetal weight, placental maturation, amniotic fluid index etc. are also evaluated.

All the information of second trimester sonography can be obtained in third trimester. Effective fetal weight, placental maturation, amniotic fluid index etc. are also evaluated.

There are many biophysical tests for prenatal fetal surveillance during late pregnancy which includes ultrasonography, doppler ultra sound velocimetry, cardiotocography(CTG), non-stress test(NSS), fetal biophysical profile(BPP), vibroacoustic stimulation test, contraction stress test (CST)etc.

There are many biophysical tests for prenatal fetal surveillance during late pregnancy which includes ultrasonography, doppler ultra sound velocimetry, cardiotocography(CTG), non-stress test(NSS), fetal biophysical profile(BPP), vibroacoustic stimulation test, contraction stress test (CST)etc.<ref>D.C Dutta, D.C.Dutta’s Text book of Obstetrics, edited by HiralalKonar, Jaypee brothers medical publishers, New Delhi, edition 8,Chapter 10 , page no:121</ref>

===Special therapies recommended during pregnancy===

===Special therapies recommended during pregnancy===

In current practice, the decoction of dashamula herbs and sesame oil processed with same herbs is used for giving evacuative enema after completion of 8th  month of gestation. The dashamula group of herbs includes  Aegle marmelos(bilwa), Premna Integrifolia/ Clerodendrum phlomidis(agnimantha), Gmelina arborea(gambhari), Oroxylum indicum(shyonaka), Stereospermum suaveolens(patala), Desmodium gangeticum(shalaparni), Uraria picta(prishniparni), Solanum indicum(bruhati), Solanum xanthocarpum(kantakari), Tribulus terrestris(gokshura).   

In current practice, the decoction of dashamula herbs and sesame oil processed with same herbs is used for giving evacuative enema after completion of 8th  month of gestation. The dashamula group of herbs includes  Aegle marmelos(bilwa), Premna Integrifolia/ Clerodendrum phlomidis(agnimantha), Gmelina arborea(gambhari), Oroxylum indicum(shyonaka), Stereospermum suaveolens(patala), Desmodium gangeticum(shalaparni), Uraria picta(prishniparni), Solanum indicum(bruhati), Solanum xanthocarpum(kantakari), Tribulus terrestris(gokshura).   

For unctuous enema, oil processed with the above drugs(dashamula) or oil processed with sida cordifolia(bala taila), preparations like dhanwanthara taila , mahanarayana taila , ksheerabala taila etc. are also in practice.  

For unctuous enema, oil processed with the above drugs(dashamula) or oil processed with sida cordifolia(bala taila), preparations like dhanwanthara taila <ref>KrishnanA.K.V,GopalapillaA .S,editors, Sahasrayoga with Sujanapriya Commentry, Tila prakarana, Ver. 42, Edition 32.Alappuzha: Vidyarambham Publishers; 2013.p. 286.</ref> , mahanarayana taila <ref> KrishnanA.K.V,GopalapillaA .S,editors, Sahasrayoga with Sujanapriya Commentry, Tila prakarana, Ver.70,. Edition 32.Alappuzha: Vidyarambham Publishers; 2013.p. 299-300.</ref>, ksheerabala taila<ref>KrishnanA.K.V,GopalapillaA .S,editors, Sahasrayoga with Sujanapriya Commentry, Tila prakarana , Ver.96, Edition 32.Alappuzha: Vidyarambham Publishers; 2013.p.315.</ref> etc. are also in practice.  

Different practices and protocols regarding enema therapy (basti) are followed.

Different practices and protocols regarding enema therapy (basti) are followed.

Evacuative and unctuous enema in alternate days for a maximum of 8 days is one protocol. In another protocol, initially, one evacuative enema followed by 3-4 unctuous enema on consecutive days is given.The decision  depends upon the  physician’s view(yukti) as per the condition and strength of the pregnant lady. In case of severe constipation and if the patient is very weak, initial unctuous enema followed by evacuative enema is effective.

Evacuative and unctuous enema in alternate days for a maximum of 8 days is one protocol. In another protocol, initially, one evacuative enema followed by 3-4 unctuous enema on consecutive days is given.The decision  depends upon the  physician’s view(yukti) as per the condition and strength of the pregnant lady. In case of severe constipation and if the patient is very weak, initial unctuous enema followed by evacuative enema is effective.

This kind of enema therapy is useful for facilitating easy delivery. Research works are being conducted on both evacuative enema and unctuous enema as part of prenatal care with an objective of promoting easy delivery.

This kind of enema therapy is useful for facilitating easy delivery. Research works are being conducted on both evacuative enema and unctuous enema as part of prenatal care with an objective of promoting easy delivery.

Two research works were conducted on evacuative enema with 200 ml of decoction of drugs of dashamula added with powder of Adathoda vasica(vasa), Piper longum (pippali and pippalimula), Piper chaba (chavya), Plumbago zeylanica(chitraka), Zingiber officinale(nagara) and Terminalia chebula(haritaki) and mixed with 60 ml of oil processed with dashamula. This enema was given after the completion of 8th month, along with unctuous enema (matra basti) using 60 ml of oil processed with dashamula in alternate days for a duration of 6 days.  These studies have reported early engagement of fetal head & timely onset of labour in 90.90% of cases as a result of the above mentioned enema(basti) procedure.

Two research works were conducted on evacuative enema with 200 ml of decoction of drugs of dashamula added with powder of Adathoda vasica(vasa), Piper longum (pippali and pippalimula), Piper chaba (chavya), Plumbago zeylanica(chitraka), Zingiber officinale(nagara) and Terminalia chebula(haritaki) and mixed with 60 ml of oil processed with dashamula. This enema was given after the completion of 8th month, along with unctuous enema (matra basti) using 60 ml of oil processed with dashamula in alternate days for a duration of 6 days.  These studies have reported early engagement of fetal head & timely onset of labour in 90.90% of cases as a result of the above mentioned enema(basti) procedure.<ref>Rajkrinti, A clinical study on effect of Basti, Yonipurana and Nasya in the management of Prasava, PG dissertation work, 2017, Dept of PTSR ,IPGT &RA, Jamnagar.</ref> <ref>Rachana Yadav, Role of basti, yonipurana, yonivarti & nasya in Prasava – an open labelled randomized comparative clinical Trial, PG dissertation work, 2019, Dept of PTSR ,IPGT &RA, Jamnagar.</ref>

    

    

A single blind comparative study, conducted in 45 primi-gravida and primipara full term pregnancy cases, per rectal administration (matra basti) of castor oil showed better results in the augmentation of labour and shortening the first stage of labour as compared to 2.5 IU of oxytocin in 1 pint of Ringer Lactate fluid administered as per the protocol of induction.  

A single blind comparative study, conducted in 45 primi-gravida and primipara full term pregnancy cases, per rectal administration (matra basti) of castor oil showed better results in the augmentation of labour and shortening the first stage of labour as compared to 2.5 IU of oxytocin in 1 pint of Ringer Lactate fluid administered as per the protocol of induction.<ref>Snehal Ambalgekar, Mamatha KV, A Clinical Study in Evaluating the Efficacy of Eranda Taila for Augmentation of Labor, J Adv Res Ayur Yoga Unani Sidd Homeo 2016; 3: 5-14.</ref>

 

===Vaginal Tampon===

===Vaginal Tampon===

{| class="wikitable"

{| class="wikitable"

|-

|-

!Month !! Drug  

!Month !! Drug<ref>KrishnanA.K.V,GopalapillaA .S,editors, Sahasrayoga with Sujanapriya Commentry, Kashaya prakarana, Ver. 1,. Edition 32.Alappuzha: Vidyarambham Publishers; 2013.p. 104.</ref>

|-

|-

|1st month || Sida cordfolia(bala)

|1st month || Sida cordfolia(bala)