Chapter CLXXIV - The Nidanam of difficult labour

Now, hear me. O Sushruta, discourse on the Nidanani of Mudhagarbha. Carrying or lifting of inordinately heavy loads, hurt (to the womb or uterus), and excessively hot, or irritating food or drink are the factors which tend to bring about an abortion of pregnancy, which is ushered in by such symptoms as show of blood and an aching pain in the uterus. The fætus continues in a liquid state (undifferentiated limbs) up to the fourth month of gestation, while it is aborted in a solidified (lit, with developed limbs) state in the fifth or sixth month of gestation. Hence, an abortion of pregnancy taking place after the fifth month of gestation is called miscarriage. As a fully ripe fruit may be felled down from a true by shaking it, so a hurt to the womb, fever, and irregular eating may bring on miscarriage of pregnancy in a woman. The enraged Vayu, by lying stuffed in the maternal passage, produces suppression of urine and an aching pain in the uterus and vagina, and obstructs the child in its passage out of the channel of parturition. Such an obstruction of the fætus is called Mudha-garbham (difficult parturition or false presentation). Cases of false presentation (Mudhagarbha) although admitting of being grouped under a large number of heads, are usually classified into four or eight forms, according as the child lies obstructed at the head of the maternal passage on account of its head proving too large for the latter, or as the bloated belly of the child proves the cause of obstruction, or as the arched back of the child hinders its downward passage, or as the child, with its one hand or both hands raised up, lies obliquely obstructed across the passage of parturition, or as the child, with its arched neck, and chin pressed on its breast, or with its sides contorted, lies stuffed in the vaginal canal. On the other hand, all these different forms of false presentation may be grouped under four sub-heads such as Sankilaka, Pratikhura, Parigha, and Vijagati. The form of false-presentation in which the child, with its hands and legs uplifted and pressed upon its head, lies obstructed in the maternal passage, is called Sankilaka. The form of false-presentation in which the two hands and legs of the child together with its head are passed out and its body lies obstructed in the passage of parturition is called Pratikhura. The form of difficult labour in which the hands and the head of the child are passed out and the rest of its body lies obstructed in the passage of child-birth is called Vijaka. In the form known as Parigha, the body of the fætus lies obliquely across the passage of parturition, in the manner of a Parigha (bolt). An enciente whose head droops down on the advent of the pain of child-birth, and who forsakes all modesty during the time, and whose body becomes cold, and on the surface of whose abdomen blue veins are found to appear, should be regarded as indicating an unfavourable termination of the labour. Absence of pain of child-birth, or of urination, defecation, etc., which invariably usher in the labour, as well as non-throbbing of the womb indicates an unfavourable prognosis. The complexion of the enciente becomes sallow, she complains of a cadaverous smell in her breath, and symptoms of tympanites present themselves on account of the bloated condition of the belly of the dead fætus in the womb. Loss of friends or of fortune, assault, and injury to the uterus are the factors that are usually calculated to bring on abortion of pregnancy. Constriction of the vulva, rigidity of the external orifice of the uterus, obstruction of the child in the maternal passage and the presence of a colicky pain in the uterus (Makalla^[1]) are the factors which accelerate death in cases of difficult labour.