Prasava Vyapad ↔ Complications of Labour

Sushruta's mudha garbha framework correctly identifies malpresentation-driven obstructed labour and explicitly states the mother's life takes precedence when the fetus cannot be saved -- an ethical priority modern obstetrics shares -- but classical management could only correct or destructively deliver, where modern caesarean section now usually saves both.

IN PLAIN LANGUAGE

Prasava vyapad are the complications of labour itself -- the baby stuck in a bad position, the placenta not coming away, and heavy bleeding after birth. Classical texts recognised these problems clearly and even stated, centuries ago, that if a baby cannot be saved the mother's life must come first -- a principle modern medicine still holds. What's changed is that a caesarean section can now usually save both mother and baby, where historically the only options were manual correction or, if the baby had already died, a destructive delivery to save the mother.

Classical teaching offers an early, honest, still-relevant statement of clinical priority (the mother's life first) and a recognisable description of obstructed labour's presentation. Modern medicine offers what determines survival now: the four-Ts framework and active management that prevent and treat postpartum haemorrhage, a rehearsed sequence for shoulder dystocia, magnesium sulphate for eclampsia, and timely caesarean section that has made destructive delivery almost unnecessary.

WHEN TO SEEK CARE

Labour that is not progressing, any heavy bleeding after birth, a placenta not delivered within an hour, sudden severe pain with collapse, or a baby's shoulders stuck after the head delivers are all same-day obstetric emergencies.

🔴 REFER IMMEDIATELY

Labour not progressing on the partograph, especially with a rising retraction ring or continuous pain between contractions (impending uterine rupture)
Bleeding of 500 mL or more after vaginal delivery or 1,000 mL or more after caesarean, or any blood loss causing haemodynamic compromise
Placenta not delivered within 30-60 minutes of birth
Sudden severe pain with shock disproportionate to visible bleeding (possible uterine inversion or concealed haemorrhage)
Shoulders failing to deliver after the head (shoulder dystocia)
Headache, visual disturbance, epigastric pain or sudden oedema with hypertension (pre-eclampsia/eclampsia warning)
Fever with offensive lochia after delivery (puerperal sepsis)
Labour not progressing as expected
Any postpartum haemorrhage
Retained placenta beyond 30-60 minutes
Suspected uterine rupture or inversion
Eclampsia or pre-eclampsia warning signs
Cord prolapse
Shoulder dystocia
Puerperal sepsis or suspected venous thromboembolism

Never do this

Do not augment an obstructed labour with oxytocin -- this can cause uterine rupture. Do not apply fundal pressure for shoulder dystocia -- it worsens impaction and can rupture the uterus. Do not attempt forcible manual removal of a placenta that will not separate, particularly with a previous caesarean scar (possible morbidly adherent placenta) -- this causes catastrophic haemorrhage. Do not apply cord traction without uterine counter-pressure and a contracted uterus, and do not give uterotonics before a uterine inversion is replaced. Do not withhold Anti-D from a rhesus-negative woman after any bleeding or loss.

🟢 SUITABLE FOR ROUTINE / COLLABORATIVE CARE

AYURVEDA SCOPE

Supportive sutika paricharya (rest, abhyanga, graded diet, lactation support) in the uncomplicated puerperium, alongside -- never instead of -- modern recognition and treatment of any emergency above.

MODERN MEDICINE SCOPE

Partograph-based labour monitoring; the power/passage/passenger analysis of obstructed labour with timely caesarean; active management of the third stage and the four-Ts approach to postpartum haemorrhage; manual removal of retained placenta with antibiotic cover; magnesium sulphate for eclampsia; the rehearsed shoulder dystocia sequence; immediate management of cord prolapse and uterine inversion; and recognition and treatment of puerperal sepsis, venous thromboembolism and postpartum psychiatric illness.

COLLABORATIVE SCOPE

Any practitioner who first recognises obstructed labour, postpartum haemorrhage, or another named emergency should begin the specific first action and arrange immediate transfer simultaneously, echoing the classical principle that the mother's welfare is never delayed for further observation.

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