Emergencies in OBGYN

by:Daxa Vaishnav

A homoeopathic practitioner may not come into the picture when a patient has such emergencies. This is mainly because there is still a misconception amongst patients and (allopathic) practitioners alike, that homeopathy is very slow in its action and rarely useful in emergencies.

I have had the unique advantage of being associated with gynecology & obstetrics for more than 21 years, and have been looking after the homoeopathic section of Gyn & Obst. at Mumbadevi Homoeopathic Hospital, Bombay. This hospital is also unique, since most of the patients who visit the out door or are admitted, are on homeopathic treatment. My unit sees at least 50 to 60 patients daily in the out patient dept. and the wards are always full. Over the past 21 years, I have learnt a lot of practical Gynecology and Obstetrics and have encountered many emergencies.

These are some of the emergencies that are commonly encountered in practice:

Gynecology

Dysmenorrhoea, Meno/metrorrhagia, Acute Pelvic Inflammatory Disease (PID) , Acute torsion of Ovarian cyst, Trauma- Genital injuries, Ectopic pregnancy, Septic shock

Obstetrics

Pernicious vomiting of pregnancy, Bleeding PV , Premature labor , Pre- eclampsia, Delayed labor, Rupture of uterus, Embolism , D.I.C./ Septicemia , P.P.H. (Post partum hemorrhage), Puerperal psychosis, Inversion of uterus

However, the ‘emergencies’ encountered by a homeopath are few, as given below:

• Dysmenorrhea

• Bleeding PV

• Acute P.I.D. (Pelvic Inflammatory Disease)

• Genital injuries

• Hyperemesis gravidarum

• Premature labor

• Delayed labor

• Threatened abortion

• Puerperal psychosis

 It needs to be stressed that many of the conditions noted above, can be treated by a homoeopath only with proper monitoring of the patient, and essentially requires hospitalization.

 The important things to keep in mind before accepting such an emergency, are not only whether you are well equipped to tackle the problem, but also whether any treatment is available in homoeopathy for that particular condition. In other words, one should be clear about the scope and limitations of homeopathy in such emergencies. Some of the limitations of homeopathy are exemplified below:

Surgical

• Congenital anomalies

• Inevitable/ Incomplete abortion

• Obstructed labor

• Ruptured uterus

• Cx tear

• Inversion of uterus

• Cryptomenorrhea

• Big uterine fibroids

• Extensive endometriosis           

• Cystic ovaries > 4 cms. (with multiple echoes on USG)

• Ca Cx/ Ca Ut

Medical

• Severe PIH/ Eclampsia

• Septic Shock

• D.I.C. (Disseminated Intravascular Coagulation)

The most important tools we have in treating these conditions, are a proper history and the examination of the patient. Unfortunately, most homoeopaths do not perform gynecological examination, either due to a lack of training or time on the part of the doctor, or shyness on the part of the patient.

 I have found that examination can save you from making gross mistakes in the diagnosis and treatment. Let me illustrate with the examples of a few cases:

1)      An 18 years old unmarried girl with a history of 3 MA (with previous irregular periods) came for the treatment of secondary amenorrhea. She had already visited two gynecologists before she came to me. Their diagnosis was stress induced amenorrhea because she had recently moved to the city for higher education and was living away from her parents (with her aunt). On examination, I was surprised to find that per abdomen palpation revealed a palpable uterus of 24-26 weeks size. The fetal parts were palpable, and the fetal heart sounds were distinctly audible! (She had obviously lied about the duration of the amenorrhea). An advanced pregnancy had been missed because nobody had cared to examine her in the past.

 2)      A homoeopathic colleague had referred a case of chronic leucorrhoea to me because even after six months of treatment, she had not improved. When I examined her, I found a very bad cervical erosion which bled on touch. I did a Pap smear that confirmed my doubt of carcinoma-in-situ. Fortunately, this patient is still alive, since we were able to detect the malignancy at a very early stage.

      Not examining the patient was a case of omission on the part of the physician. 

 3)      Another case was referred to me by a homeopathic colleague where the patient had a  history of 2 MA, with bleeding PV for the past 2 weeks. The referring physician had considered this to be a case of delayed periods due to “weather changes”. As the patient had not stopped bleeding in spite of his treatment, he referred her to me. The PS (per speculum) examination revealed products of conception at the cervix. This was a case of incomplete abortion and required a D & C.

Another example of how examination helps to determine the choice of the remedy is this example of prolonged labor:

 

GELSEMIUM  Patient tired and drowsy “As if foetus ascending with pains” PA: Ut. Relaxed PV: Cx- hard, unyeilding (rigid os) or soft putty like (uterine atony)     Membranes bulging, but no contractions

BELLADONNA  Elderly primipara Pains- infrequent;sudden onset and regression PA: Ut. Contractions infrequent PV: Hot & tender vagina, Cx tightly closed/ spasmodic or Cx muscles contracted

 Apart from the above, there are two or three more drugs that I use frequently in cases of prolonged labor (e.g. Actea racemosa, Caulophyllum, Pulsatilla), but I have purposely not stressed on this emergency, because most of you may not need to treat it.

The theory behind tackling emergencies is available in all books on therapeutics, which list the drugs for the different conditions. My aim is to share with you my experiences in treating such conditions and I wish to give you only practical hints, and what I find useful in prescribing the drug.

Ideally, we should give constitutional treatment to our patients, but when the patient comes with an acute emergency, we may have to rely on either the cause or some peculiar symptoms or peculiar examination findings to make our prescription.

 An example is Abortion.

Another common problem that we face in gynecological practice is dysmenorrhea. Very often, the severe uterine cramps or the other accompanying symptoms incapacitate the patient. In fact, in general homoeopathic practice dysmenorrhea is a common symptom associated with the chief complaint. The best option is to start the constitutional treatment, which should take care of the pains. However, in the acute state, we have to think of an acute remedy. This may sometimes be a remedy related to the constitutional drug, e.g.- Belladonna as the acute of Calcarea carbonica, Colocynth as the acute of Staphysagria, etc.). Often, we have to rely on some lesser-known remedies to treat the dysmenorrhea.

 

A few cases to drive home the point:

1.  An 18 years old patient came with severe spasmodic dysmenorrhea. She complained of severe lower abdominal cramps with profuse bleeding PV. What was peculiar was that the flow started only after the pain had subsided. Again, when the pain came on, the flow reduced. She was weak and exhausted due to the pain and the bleeding.  Cocculus 200, 3 pills every 2 hours took care of the pains and bleeding with just 2 doses. This is the only drug listed for this symptom in Kent’s repertory.

2.    A student of my college, 20 years old, came rushing to the OPD with her friend. She collapsed on the chair and her friend gave the history. She had severe pain in the lower abdomen and was menstruating. I found her hands icy cold to touch and she was rolling her eyeballs. When she regained her consciousness, she said that her dysmenorrhea was excruciating and was clutching her lower abdomen. I asked the nurse to get Tabacum 200 and gave her one dose immediately. She was asked to repeat it if required and to get back to me in a couple of hours. Just a dose took care of the pain and the faintness and she did not require a repetition of the dose.

3.  Another young girl of 20 came with pain in the lower abdomen. She felt sore and heavy in the pelvic region. She seemed to feel better after milk and after a good menstrual flow. The pain seemed to begin in the sacral region, coming to the front and radiating down the thighs. Two doses of Viburnum opulus 200 were all it took to relieve her suffering.

A nervous, emotional girl came with acute dysmenorrhea. She complained that her pain increases as the flow increases. The menstrual cycles were irregular. This short totality made me think of Cimicifuga (Actea) racemosa. The 200 potency was given repeatedly which controlled her pain as well as her menorrhagia in a few hours.

 Menorrhagia is another complaint of women and there is often the need to prescribe the lesser-known remedies to control the hemorrhage:

 Cinnamonum: Profuse bleeding caused by a strain or misstep (when no other remedy works)

Erigeron: Bright red with clots, and irritation of bladder and rectum < least motion

Hamamelis: Passive, painless, venous hemorrhage; soreness of the uterus; menses only

during the day

Thlaspi bursa pastoris: Every alternate period profuse; uterine fibroids with cramps and expulsion of clots; menses and leucorrhoea leave a fast stain; sore pain in womb < rising

Trillium pendulum: Menses every 2 weeks; blood bright red, gushing with faintness and dizziness; sensation as if bones of hip, back thighs are falling to pieces or forced apart > tight bandage

Ustilago: Dark red, half liquid and half clotted < slight provocation; at climacteric or after abortion; cervix spongy, easily bleeding; uterus- hypertrophy; sub-involution

         Vinca minor: Specific for uterine/cervical polyps; continuous hemorrhage with debility;     post menopausal bleeding

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