HOMOEOPATHIC THERAPEUTICS OF ABNORMALITIES OF PUERPERIUM

Informative presentation for BHMS students for Therapeutics in Abnormal Puerperium.

1. THERAPS ON ABNORMALITIES OF PUERPERIUM DR. D. Y. PATIL HOMOEOPATHIC MEDCIAL COLLEGE AND RESEARCH CENTRE DR. RADHIKA KHANDELWAL ASSISTANT PROF. DEPARTMENT OF GYNAECOLOGY AND OBSTETRICS

2. ABNORMALITIES OF PUERPERIUM

3. PUERPERAL PYREXIA DEFINITION – A rise of temperature reaching 100.4°F (38°C) or more (measured orally) on two separate occasions at 24 hours apart (excluding first 24 hours) with in first 10 days following delivery is puerperal pyrexia. CAUSES – Puerperal sepsis UTI Mastitis Infection of caesarean section wound Pulmonary infection

4. PUERPERAL SEPSIS DEFINITION – An infection of the genital tract which occurs a complication of delivery is termed as puerperal sepsis. CAUSES – Endometritis Endomyometritis Endoparametritis or a combination of all three.

5. PUERPERAL SEPSIS PREDISPOSING FACTORS - ANTEPARTUM FACTORS Malnutrition and anaemia Preterm labour PROM Chronic debiliting illness Prolonged rupture of membranes PREDISPOSING FACTORS – INTRAPARTUM FACTORS Repeated vaginal examinations Prolonged rupture of membranes Dehydration & keto-acidosis Traumatic operative delivery APH/PPH Retained placenta/membranes Placenta praevia Caesarean delivery

6. PUERPERAL SEPSIS CLINICAL FEATURES LOCAL/WOUND INFECTION Slight rise of temperature Generalized malase/headache Wound red swollen Pus formation SPREADING INFECTION Pelvic peritonitis Parametritis General peritonitis Thrombophlebitis Septicemia UTERINE INFECTION MILD – Rise in temperature, raised pulse rate, lochial discharge offensive & copious, Uterus sub-involuted & tender. SEVERE – Acute onset with high fever, with chills & rigor; rapid pulse; lochia scanty & odorless; tender uterus; associated wound infection.

7. URINARY COMPLICATIONS IN PUERPERIUM

8. BREAST COMPLICATIONS BREAST COMPLICATIONS BREAST ENGORGEMENT CRACKED OR RETRACTED NIPPLE MASTITIS LACTATION FAILURE Its is due to exaggerated normal venous and lymphatic engorgement of the breasts which precedes lactation. Its is due to unclean hygiene; retracted nipple; trauma from baby’s mouth CAUSES – Infrequent suckling Depression or anxiety state Reluctance or apprehension to nursing Ill development of the nipples Painful breast lesion CAUSES – Poor nursing Maternal fatigue Cracked nipple

9. PUERPERAL VENOUS THROMBOSIS/PULMONARY EMBOLISM PREDISPOSING FACTORS – Vascular stasis Hypercoagulability of blood Vascular endothelial trauma Advanced age and parity Operative delivery Obesity Anaemia PREDISPOSING FACTORS – Heart disease Infection-pelvic cellulitis Trauma to the venous wall Immobility Smoking Prior DVT or PE

10. PUERPERAL EMERGENCIES

11. PSYCHIATRIC DISORDERS DURING PUERPERIUM HIGH RISK FACTORS – Past history – psychiatric illness, puerperal psychiatric illness. Family history – major psychiatric illness, martial conflict, poor social situation. Present pregnancy – young age, caesarean delivery, difficult labour, neonatal complications. Others – unmet expectations. DISORDERS ARE – Puerperal blues Post partum depression Post partum psychosis

12. HOMOEOPATHIC APPROACH

13. HOMOEOPATHIC APPROACH CASE TAKING – Date of delivery Obstetric & gynecological history in detail Chief complaints – in detail with exact ODP of symptoms Physical examination – Abdomen, stitches, breast examination Investigations – Urine routine & culture; Haemogram; Blood culture; Pelvic sonography. SUSCEPTIBILITY – High INDIVIDUALISATION – The clinical picture will be seen, but the sensations, modalities will make the case individualized.

14. HOMOEOPATHIC THERAPEUTICS Aconitum napellus Arnica montana Bryonia alba Lachesis Pyrogen Rhus toxicodendron Secale cor Baptisia Belladonna Cicuta virosa Causticum Hyocyamus niger Trillium pendulum Cyclamen Viburnum prunifolium Chinium sulphuricum

15. ACONITUM NAPELLUS MENTALS MODALITIES GENERALS PARTICULARS Physical & mental restlessness, & fright are most characteristic feature of aconitum. Acute, sudden & violent invasion, with fever, calls for it. First remedy in inflammation & inflammatory fevers. Action is brief & shows no periodicity. Aconite causes only functional disturbance, there is no evidence that is can produce tissue changes. Great fear, anxiety & worry accompany every ailment, however trivial. Fears death, but believes that he will soon die, predicts the day. Fears future. Restlessness, tossing about. Cold stage is marked; cold sweat & icy coldness of the face. Coldness & heat alternates. Cold waves pass through the body. Thirst & restlessness always present. Most valuable medicine for fever with mental anxiety, restlessness. WORSE – warm room, evening, at night, lying on affected side, from music, from tobacco, smoke, dry, cold wines. BETTER – open air.

16. ARNICA MONTANA MENTALS MODALITIES GENERALS PARTICULARS It is especially suited to cases when any injury, however remote, seems to have caused the present problem. After traumatic injuries, overuse of any organ strains. Tendency to tissue degeneration, septic conditions, abscesses that do not mature. Sore, lame, bruised feeling. Fear touch, or approach of anyone. Inability to perform continuous active work. Agrophobia (Fear of space). Want to be left alone. Bruised parts after labour. Violent after pains. Sore nipples. Mastitis after injury. Febrile symptoms closely related to typhoid. Shivering all over the body. Heat & redness of head, while rest of the body is cold. Internal heat; hands & feet cold. Sour sweat at night. WORSE – least, touch, motion, rest, wine, damp, cold. BETTER – lying down, lying with head low.

17. LACHESIS MUTUS MENTALS MODALITIES GENERALS PARTICULARS Lachesis decomposes blood, rendering it more fluid; hence haemorrhagic tendency. Purpura , septic states, diphtheria & other forms of disease, when the systems is thoroughly poisoned & prostration is profound. Great loquacity. Sad in the morning; no desire to mix with the world. Suspicious; nocturnal delusion of fire. Derangement of time sense. Left ovary very painful & swollen, indurated. Mammae inflamed, bluish (mastitis). Chills in back; feet icy cold; hot flushes & hot perspiration. WORSE – after sleep, left side, in spring, warm bath, pressure or constriction, hot drinks, closing eyes. BETTER – appearance of discharges, warm applications.

18. PYROGENIUM MENTALS MODALITIES GENERALS PARTICULARS Great remedy for septic states, with intense restlessness. In septic fevers, especially puerperal, pyrogenium has demonstrated its great value as a homoeopathic dynamic antiseptic. Typhus, dissecting wounds, after affects of miscarriage. All discharges are horribly offensive – menstrual, lochial, diarrhoea, vomit, sweat, breath, etc. Full of anxiety & insane notions. Restlessness. Cannot tell whether dreaming while awake or asleep. Feels as if crowded with arms & legs. Puerperal peritonitis. Septicemia following abortion. Septic puerperal infection. PID, inflammatory exudate. Post-operative cases with over-whelming sepsis. Septic fevers, temperature rises rapidly. Great heat with profuse hot sweat, but sweating does not cause a fall in temperature. BETTER – by motion.

19. BAPTISIA TINCTORIA MENTALS MODALITIES GENERALS PARTICULARS Simulating low fevers, septic conditions of the blood. Great muscular soreness & putrid phenomena are always present. Thinks he is broken or double & tosses about in bed trying to get pieces together. Delirium, wandering, muttering. Falls asleep while being spoken to. Mental confusion, ideas confused. Threatened miscarriages from mental depression, shock, night watching, low fevers. Puerperal fever. Chills with rheumatic pains & soreness all over the body. Chills around 11 am. Adynamic fever. WORSE – humid heat, fog, indoors.

20. BELLADONNA MENTALS MODALITIES GENERALS PARTICULARS It has marked action on vascular system, skin & glands. Neuralgic pains that come & go suddenly. Heat, redness, throbbing & burning. No thirst, anxiety or fear. Belladonna stands for violence of attack & suddenness of onset. Patient lives in a world of his own. Hallucinations; sees monsters, hideous faces. Delirium; frightful images; furious; rages, bites, strikes; desire to escape. Acuteness of all senses. Retention of urine. Acute urinary infections. Sensation of motion in bladder, as if a worm. Urine scanty, with tenesmus; dark & turbid, loaded with phophates. Vesical region sensitive – cystitis. Incontinence, continuous dripping. WORSE – touch, jar, noise, draught, afternoon, lying down. BETTER – semi-erect position.

21. CICUTA VIROSA MENTALS MODALITIES GENERALS PARTICULARS Affection of nervous system. Strange and vivid dreams. Touch & little noise bring on convulsions. Difficult hearing. Everything seems to be strange and terrible. Unable to recognise family members. Fails to recollect what has occurred just few minutes before. Melancholic and indifferent. Iirelevant talk confused state of mind. Irritability due to pressure on the genital tract during labour. Pressure and progress of labour causes convulsion, which goes from centre to circumference. Vertigo with gastralgia . WORSE – touch, jar, noise, draught, afternoon, lying down. BETTER – semi-erect position.

22. THANK YOU DEPARTMENT OF GYNAECOLOGY AND OBSTETRICS