When the pregnancy gets terminated and there is bleeding, it is called as abortion. This can be caused due to a number of reasons, including the use of unwholesome food or improper regimen. If the bleeding occurs during the second or third month of pregnancy, then the pregnancy can not be stable because during this period the embryo lacks maturity. After the fourth month this may not be very critical and one can maintain the pregnancy, despite bleeding.

Garbha sraava/ Garbha paatha

The expulsion of foetus upto fourth month of pregnancy is termed as garbha sraava, because the product of conception is in a fluid form. After the fifth and sixth months it is termed as garbha paatha as by this period the foetal parts have attained some stability of have become solid. The causes for these could be many, such as excess of-anger, grief, envy, jealousy, fear, terror, cohabitation, exercise, jerk, suppression of vegas (manifested urges), improper food, sleep and posture, hunger, thirst and intake of unwholesome food.

Sampraapthi: (Pathogenisis)
When the foetus gets detached from its bonds, its bonds, it exceeds the normal limits within the uterus and descends downwards from the hollow space between liver, spleen and bowels. It then produces irritation in the abolominal cavity which in turn causes the agravation of apaana vaayu. This results in pain in the flanks, kukshi (lower abdomen or uterus), basthi sheersha (neck of the bladder), abdomen and vagina, along with flatulence or distention of abdomen, retention of urine and several other symptoms, troubling the young foetus with bleeding.

When this happens the following symptoms are manifested : pain in the uterus, sacral and groin region and over the urinary bladder along with bleeding. The cause of the pain is the vitiation of vaayu and the bleeding is due to expulsion of aama-garbha and opening of orifices of aarthavavaha sroehases.

Treatment

As the Garbhopaghathakara bhaavas are ushna teekshna and saaraka in guna, the general principles for treating abortion is similar to garbha sthaapaka aahaara, vihaara and aushadas. Thus the treatment given is always sheetha, mrudu and sthambaka in nature.

1. Immediately after bleeding is noticed the mother should be advised to lie down in slanting position so that her head is at a lower level and the leg at a higher level, on a bed which is soft, cooling, comfortable and cooling

2. The entire body below the navel should be smeared with shathadowtha ghrutha and sahasra dowtha ghrutha and sprinkled with cold (chilled) cow's milk, decoctions of yashti madhu (Glycyrrhiza glabra) or nyagrodha (Ficua bengalensis).

3. One of the following medicated pichus (douches/tampons) can be given-
   1. Cotton swab dipped in the juices of ksheeri vrukshas - trees which exude a white fluid on being cut (This term is especially used to denote trees of the Ficus family e.g. Ficus religiosa, Ficus bengalensis etc). and trees having astringent taste.

   2. Cotton swab dipped in milk or ghee boiled with the sunga (bud) of nyagrodha (Ficus bengalensis).

   3. A cotton swab dipped in ghee mixed with the powder of yashtimadhu (Glycyrrhiza glabra).

4. Internally she can be given milk or ghee boiled with buds of nyagrodha (Ficus bengalensis) in a dose of one aksha (12 ml) or even plain milk ghee.

5. Psycologically she should refrain from anger and sorrow. She should be entertained with talks which are gentle and pleasing to her mind. She should further avoid exertion exercise and cohabitation (Cha. Sam., Sha. 8/24).

Conditions when the abortion should be left untreated, to proceed

1. When the bleeding has been very severe and would have caused irrepairable damage. In such cases even if the abortion is treated and stopped, there could be some damage/deformity in the foetus, caused due to the acute blood loss.

2. If the bleeding is due to the factor which also causes the formation of "aama", then the abortion will have to proceed and left untreated, because any treatment for the abortion which should be saumya, sheetha and murdu would only aggravate the "aama" condition. So in such a situation even if we try to stop the abortion the toxicity of the "aama" which develops further would only prove harmful both for the mother and the foetus. Thus we are left with no choice but to treat the "aama" and allow the abortion to take its course.

Post-abortion treatment
Treatment should be given after expulsion of the products of conception, to cleanse or help complete evacuation and for relief from pain. The line of treatment in general is opposite to the treatment given to prevent the abortion. The treatment given here is generally ushna, teekshna and paachana in nature.

1. Wine can be given considering her strength.

2. A fat free gruel medicated with drugs of laghu panchamoola* can also be given. They would control the vaatha which could be in an aggravated condition and also decrease the pittha which would be increased by the intake of wine. Being balya (tonic) they help the woman to regain strength which would be lost due to the acute bleeding caused.

• Laghu panchamoola group consists of the following drugs - Shaliparni (Desmodium gangeticum), prishniparni (Urariapicta),kantakaari (Solanum xanthocarpum), gokshura (Tribulus terrestris) and bruhathi (Solanum indicum).

3. For a woman who is not inclined to the use of wine, either fat and salt free gurel made with thila and uddalaka mixed with paachaka dravyas, or a beverage made of thila, uddalaka or rice prepared with decoctions of bruhat panchamoola* and medicated with the paste of panchakola** can be given. As the lady is not given wine, there is no increase in pittha. It acts on the excess of kapha and also the deepana action of alcohol is substituted by deepana action of bruhat panchamoola. it also acts on the aggravated vaatha. Panchakola drugs are all deepana and paachana and thus help the women to regain her appetite and help in the proper evacuation of the products of conception. These diets should be used for the same number of days only. It would help proper cleansing of the uterus and relieve her of stiffness and pain in the hip region and flanks

4. Use of swedana - Swedana actually means application of heat and induced sweating. Swedana helps in cleaning the channels, as it dialates the srothases and promotes excretion.

• *Bruhat panchamoola drugs are bilwa (Aegale marmelos), agnimantha (Premna latifolia), syonaaka (Oroxylum indicum) paatala (Streospermum svaveolens) and gambhaari (Gmelina arborea)

• ** They are pippali (Piper longum), pippalimoola, cavya (Piperchaba), chitraka (Plumbago zeylanica), shunti (Zingiber officinale)

Habitual Abortion
Some women have a tendency for abortion and the slightest of exertion and even normal movements tend to cause abortion. In such cases, preventive medicines, aimed at treating the cases of habitual or repeated abortion can be attempted.
The powder or paste of the following drugs should be used with milk in the particular months, which would help the foetus to grow properly.

1. First month :
   Madhuka (Glycyrrhiza glabra), shaakabeeja, payasya (Ipomoea paniculata) and suradaaru (Cedrus deodara)

2. Second month :
   Ashmantaka (Banuhimia malabarica), black tila, taamra valli and shataawari (Asparagous racemosa).

3. Third month :
   Vrukshaadini, payasya, lata, utpala, and saarivaa (Hemidesmus indicus)

4. Fourth month :
   Ananta (Gardenia floribunda), saarivaa (Hemidesmus indicus), raasna (Pluchea lanceolata), padma, madhuka (Glycyrrhiza glabra).

5. Fifth month :
   Bruhatidwayam, kaashmari (Gmelina arborea), stem bark and leaf buds of latex yielding trees and ghruta.

6. Sixth month :
   Prishniparni (Uraria picta), bala (Sida cardifolia), or vacha (Acorus calamus), shigru (Moringa olifera) swadamshtra and madhuparnika.

7. Seven month :
   Sringaataka (Trapa bispinosa), bisa, draaksha (Vitis Vinifera), kasheru madhuka (Glycyrrhiza glabra) and sugar.

8. Eight month :
   Milk treated with roots of kapittha, bilwa (Aegle marmelos), bruhathi (Solanum indicum), patola (Trichosanthes dioica) ikshu, nidigdhika.

9. Ninth month :
   Milk treated with anantha, saariva (Hemidesnus indicus), payasya (Ipomea paniculata) and madhuyashti (Glycyrrhiza glabra).

10. Tenth month :
    Milk treated with either shunti (Zinziber officinale), and payasya (Ipomea paniculata) or only payasya (This relieves even very severe pain).