Managing FGR Due to Placental Insufficiency with Narikela Rasayana - A Case Report

Abstract

Fetal Growth Restriction (FGR) is a significant pregnancy complication with risks of perinatal morbidity and long-term developmental issues. Conventional management mainly involves monitoring rather than intervention. This case report presents Ayurvedic management of FGR in a 46-year-old G3P2L2 woman at 25 weeks gestation, showing reduced fetal biometrics and borderline amniotic fluid. Treatment with Narikela Rasayana and Kharjuradi Mantha was administered orally for four doses over one week, alongside conventional medications (low-dose aspirin and labetalol). Serial ultrasonography revealed improvement in Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC), Estimated Fetal Weight (EFW), and amniotic fluid index. The patient delivered a stable male neonate via emergency LSCS at 27 weeks. No adverse maternal or fetal effects were observed.

Introduction: FGR occurs when a fetus fails to achieve its growth potential, often due to placental insufficiency or maternal comorbidities. Ayurvedic literature describes Garbhavriddhi as governed by Matruja Rasa Dhatu and Vata Dosha; their imbalance leads to Garbhashosha. Nutritional milk-based preparations (Brihmaniya Ghana Siddha Ksheeraprayoga) are recommended to enhance fetal growth.

Objectives: Evaluate Ayurvedic intervention in idiopathic FGR, observe clinical and ultrasonographic changes, and explore correlations between Garbhashosha and modern FGR diagnosis.

Methods & Clinical Findings: The patient had gestational hypertension, fatigue, and smaller-than-expected fundal height. Ultrasound confirmed early-onset FGR with EFW 454 g and abnormal Doppler flows. Hemoglobin was 11.8 g/dL.

Therapeutic Intervention: Narikela Rasayana with Kharjuradi Mantha (90 ml orally) was given four times over a week, alongside ongoing aspirin and labetalol.

Outcome & Follow-Up: Post-treatment, EFW increased to 512 g, fundal height and maternal hemoglobin improved. Emergency LSCS delivered a stable neonate weighing 780 g.

Discussion: Ayurvedic therapy nourishes Rasa Dhatu and pacifies Vata Dosha, supporting fetal growth. Ingredients like Shatavari, Ashwagandha, Bala, and Yashtimadhu provide antioxidant, anti-inflammatory, and adaptogenic benefits, improving uteroplacental circulation and fetal nutrition.

Conclusion: Ayurvedic intervention, alongside conventional therapy, can support fetal growth in FGR cases. Larger studies are needed to validate efficacy and develop standardized protocols.