Effect of Prajasthapana Mahakashaya Ksheerabasti along with oral medication on low amniotic fluid index: A case series

Abstract BACKGROUND: Oligohydramnios is the most common amniotic fluid disorder, characterized by reduced amniotic fluid volume that is less than expected for gestational age. Low amniotic fluid index (AFI)/borderline oligohydramnios is considered when the AFI value ranges between 5 cm and 8 cm. According to Ayurvedic principles regarding the symptoms and pathophysiology, this condition is considered Garbha Shosha, Vatabhipanna Garbha , and Upavishtaka , which can be correlated with intrauterine growth restriction and low amniotic fluid volume, where a reduced fundal height relative to the period of gestation is one of the cardinal symptoms. PATIENT INFORMATION: In this case series, we report cases of low AFI (borderline oligohydramnios) during the third trimester, with no evidence of detectable maternal or fetal pathology and no leaking of fluid per vaginum. The diagnosis was made during routine antenatal evaluations. Per abdominal examination revealed a reduced fundal height relative to gestational age, which was subsequently confirmed by sonographic assessment, supplemented with Doppler flow studies of both feto-placental and uteroplacental circulations. THERAPEUTIC INTERVENTION: The treatment opted was administration of Ksheerabasthi (milk decoction enema) and specific Ayurveda therapeutic interventions along with routine antenatal treatment. The outcome measure involved tracking changes in amniotic fluid levels through serial ultrasound (USG) assessments. RESULTS: A significant improvement in AFI values was observed in all cases, and each pregnancy progressed to term with favorable neonatal outcomes, as indicated by good Appearance, Pulse, Grimace, Activity, and Respiration scores at birth. CONCLUSION: This case series highlights the potential role of Ayurvedic interventions including Ksheerabasti —in the management of low AFI (borderline oligohydramnios). The findings suggest a promising therapeutic approach warranting further exploration. We recommend conducting randomized clinical trials to scientifically validate the efficacy of Ksheerabasti in improving amniotic fluid levels.