Ayurvedic Management of Oligohydramnios: A Case Report on the Use of Ksheerabasti for Enhancing Amniotic Fluid Volume

Introduction
            Amniotic fluid plays a critical role in fetal development, providing space for movement, aiding in gastrointestinal and lung maturation, and preventing umbilical cord compression. Oligohydramnios is characterized by a significant reduction in amniotic fluid, with less than 200 ml of fluid, an Amniotic Fluid Index (AFI) below 5 cm, a maximum vertical pocket of fluid measuring less than 2 cm, and a 2D pocket less than 15 cm. This condition increases the risk of fetal distress, umbilical cord compression, meconium-stained liquor, operative deliveries, and stillbirth at term. Symptoms commonly include reduced fetal movement, which can be correlated with Ayurvedic concepts such as Manda Spandana of garbha (decreased fetal movement) and Anunatakukshita (reduced fetal growth). These are akin to the Ayurvedic conditions Garbhashosha (reduced amniotic fluid or fetal distress) and Gabhakshaya (fetal malnutrition), as described by Acharya Sushruta.

            In Ayurveda, the treatment of oligohydramnios at term follows the principles for managing Garbhashosha and Gabhakshaya, aiming to promote fetal health and ensure normal delivery. Modern medicine suggests the use of arginine to improve amniotic fluid levels, whereas Ayurveda recommends nourishing therapies, such as Medhyaanna for Garbakshya [1] and Brimhaniyapaya (milk-based therapies) for Garbhashosha [2]. In this study, a combination of Shatavari, Ashwagandha, Gokshura, Vidarikanda, Yashtimadhu, and Phalaghrita was used in the form of Ksheerbasti to treat oligohydramnios, promoting fetal growth and improving amniotic fluid levels without adverse side effects.

Patient Information

A 25-year-old primigravida patient presented to the OPD of the Department of Prasutitantra and Streeroga at the National Institute of Ayurveda, Jaipur, on July 15, 2024, at 4.5 months of amenorrhea. Ultrasound confirmed a single live intrauterine pregnancy with normal growth parameters. The patient was advised regular follow-up visits, a balanced diet rich in fluids, iron, and calcium, along with routine antenatal ultrasounds. Subsequent ultrasounds showed adequate amniotic fluid and normal parameters.

However, due to dietary negligence, the patient reported a decrease in fetal movement starting the night of November 13, 2024. She presented the following morning with an ultrasound showing a single live intrauterine fetus at 36 weeks and 1 day, with reduced amniotic fluid (6-7 cm) and a biophysical profile of 6/8, with a fetal heart rate of 136 bpm. The patient was treated with Ayurvedic management, including Shatavari, Ashwagandha, Gokshura, Vidarikanda, Yashtimadhu, and Phalaghrita in the form of Ksheerbasti.

Clinical Findings

General Examination:

• General Condition: Good
• Blood Pressure: 100/70 mm Hg
• Pulse Rate: 80/min
• Temperature: 98.3°F
• Height: 5’4″
• Weight: 69 kg
• BMI: 26.3 kg/m²
• Pallor: Absent
• Pedal Edema: Absent

Systemic Examination:

• Digestive System: NAD
• Cardiovascular System: NAD
• Respiratory System: NAD
• Central Nervous System: NAD

Abdominal Examination:

• Fundal Height: 34-36 weeks of gestation
• Fetal Lie: Longitudinal
• Fetal Presentation: Cephalic
• Fetal Heart Rate: 142 bpm
• Uterus: Relaxed

Personal History:

• Appetite: Normal
• Sleep: Disturbed
• Bowel Movements: Clear
• Bladder: Clear
• Addiction: None
• Diet: Vegetarian

Past Medical History:

• Nil

Past Surgical History:

• Nil

Family History:

• Not significant

Allergic History:

• None

Menstrual History:

• Age of Menarche: 13 years
• Duration of Menses: 3-4 days
• Interval of Menses: 28-30 days
• Last Menstrual Period: 05/03/2024
• Expected Date of Delivery: 10/12/2024

Obstetric History:

• Gravida 1, Para 0, Live Birth 0, Abortion 0 (G1 P0 L0 A0)
• Married Life: 1 year

Antenatal Investigation:

• All blood and urine investigations normal

Timeline

The patient was advised a course of Ksheerbasti (Shatavari, Gokshura, Mulethi, Vidarikanda, Ashwagandha, and Phalaghrita) for seven days. After the course, another ultrasound was recommended to assess changes in amniotic fluid volume.

Method of preparation and route of administration of ksheerabasti

To prepare Ksheerbasti, a fine powder of Shatavari, Gokshura, Mulethi, Vidarikanda, and Ashwagandha, each in equal amounts of 5 grams (totaling 25 grams), is boiled with 350 ml of milk (Ksheera) and 350 ml of water over mild heat (Mandagni) until only the milk remains. After this, Phalaghrita (30 ml) is added to the Ksheerapaka and mixed thoroughly. The preparation is then filtered through a fine sieve to remove any solid particles. The resulting lukewarm mixture (350 ml) is administered rectally in the Nyubja Avastha (knee-elbow position) with the help of an enema can.

Table No. 1: Schedule of Ksheerbasti Administration

Table No.2.Ultrasonography findings

 Outcome
Post-treatment, the patient observed a gradual improvement in fetal movements. Each visit showed consistent improvements in fundal height, aligning with the period of amenorrhea. A follow-up ultrasound on 20/11/2024 confirmed a single live fetus of 35 weeks 6 days with an AFI of 10.12 cm, fetal heart rate of 130 bpm, and normal fetal movement. The estimated fetal weight was 2691 +/- 404 gm. This improvement in the amniotic fluid index and overall fetal health demonstrated the effectiveness of the Ayurvedic intervention.

Discussion
                  Oligohydramnios is a clinical condition marked by a reduced volume of amniotic fluid, which is crucial for fetal development. In Ayurvedic terms, oligohydramnios is thought to result from the depletion (Kshaya) of the Jaliya-mahabhuta (water element), which in turn leads to an imbalance in the body’s natural fluid dynamics. This depletion results in conditions like Garbhashosha (fetal distress due to reduced amniotic fluid) and Gabhakshaya (fetal malnutrition or growth restriction), as described by Acharya Sushruta. These conditions impede the normal development of the fetus and the amniotic fluid that envelops it.

                  In the classical Ayurvedic approach, the treatment of oligohydramnios is aimed at restoring balance to the Jaliyatatva (water principle) and nurturing the fetus. For managing Garbhashosha, Acharya Sushruta recommends Brimhaniya paya (milk-based therapies), which nourish the body and enhance the production of amniotic fluid. For Gabhakshaya, which refers to fetal growth retardation, Medhyanna (nourishing food) is prescribed to improve fetal health and development.

                  In this study, the combination of Shatavari, Ashwagandha, Gokshura, Vidarikanda, Yashtimadhu, and Phalaghrita was administered in the form of Ksheerbasti. This formulation, which possesses Madhura rasa (sweet taste), Madhura vipaka (sweet post-digestive effect), Sheeta veerya (cooling potency), and Snigdha and Guru (unctuous and heavy qualities), is known to enhance the Jaliyatatva, thereby improving the amniotic fluid volume. Additionally, Ksheerbasti pacifies Apana Vata (the downward-moving Vata dosha), which is responsible for the expulsion of waste and the regulation of bodily fluids. By enhancing uteroplacental blood flow, Ksheerbasti promotes the production of amniotic fluid.

                  Furthermore, the Snigdha (unctuous) and Sheeta (cooling) properties of the formulation nourish and hydrate the body, helping to balance fluid levels within the uterus and support uterine health. The rejuvenating (Rasayana) properties of the herbs improve maternal and fetal nourishment, enhancing vitality and overall health. The amino acids and flavonoids present in these herbs may help neutralize free radicals, thereby protecting the fetus from oxidative stress, promoting its growth, and maintaining normal fluid volume in the uterus.

                  The observed improvement in fetal movement and the increase in the Amniotic Fluid Index (AFI) from 6-7 cm to 10.12 cm post-treatment is a promising outcome that suggests the efficacy of Ayurvedic interventions like Ksheerbasti in managing oligohydramnios. The significant enhancement in amniotic fluid volume and fetal well-being demonstrates the potential of Ayurvedic medicine in the management of pregnancy-related conditions. Further research with larger sample sizes and long-term follow-up studies would be valuable to confirm these findings and validate the role of Ayurvedic treatments in obstetric care.