Integrative Medicine Case Reports, Volume 4, Issue 2 (July), 2023

Efficacy of Yoga therapy as Non-pharmacological management in Women with High-risk Pregnancy: A Single Case Report

Reshma P. Jogdand,^1* Satyapriya Maharana,¹ Nagarathna R.,¹ Anuradha Kanana,² Santosh³ and Suryanarayana⁴

¹Department of Life science, SVYASA Bangalore, India
²Department of Obstetrics and Gynaecology, Narayana Health care, Bangalore, India
³Department of Doppler study, Narayana Health care, Bangalore, India
⁴Department of Yoga and Physiotherapy, Narayana Health care, Bangalore, India

Introduction

Pregnancy is a life-changing experience for women. Many changes occur in the female body physically, emotionally, and psychologically. Placenta is the first structure that forms between the mother and fetus. It is a connection or bridge to provide nutrition and oxygen to a fetus for its growth and development. A placental disease is any disease, disorder, or pathology of the placenta (1). The placenta starts organogenesis in the very early stage of embryogenesis, governs fetal growth, and terminates its fate immediately after delivery. Placental perfusion is maintained by two different cardiovascular systems, i.e., maternal blood flow and fetal circulation. Therefore, the pathophysiology of the placenta is closely associated with maternal status and fetal development (2) (Figure 1).

Figure 1: The diagram illustrates mechanism of Placental Pathology and effect of yoga intervention.

Placental disease/Pathology is abnormalities present within spiral arteries of the uterus. The terminal part of spiral arteries doesn’t dilate due to the lack of oxygen supply, carried from the maternal villa into Intravillus space, but because of lack of terminal dilatation in shredding of the villa into maternal blood, as such coagulation occurs resulting in the blockage of blood vessels leading to Placental infarction (3). The preva­lence of placental pathology in low birth weight infants was 80.7%. The four types of placental pathology were related to low birth weight, Intrauterine Growth Restriction (IUGR), vascular anomalies of the deciduas, and Premature labour (4).

Approximately 800 women die during Pregnancy or childbirth every day (5). Obstetric hemorrhage (antepartum and postpartum), sepsis, and Hypertension during pregnancy accounts for more than 50% of maternal deaths worldwide, 99% of which occur in low- and middle-income countries (5). The World Health Organization estimates that approximately 15 million babies are born prematurely every year, and 1 million of these babies die despite the interventions that is capable of saving 75% of lives (6).

The overall estimated Still Birth Rate in the study popu­lation from the nine states in India was approximately half that of the WHO estimated rate of 22 per 1000 total births (7). It is observed that the Cesarean Section (CS) births increase with the advancing age of the women at the time of first delivery from 15.1% in ages less than 19 years to 53.2% of those over 35 is considered high-risk Pregnancy due to placental abnormalities. Women with high blood pressure during Pregnancy had a significantly higher proportion of CS births than those who had normal blood pressure (35.1% vs. 22.6%) (8).

Stillbirths and neonatal passing are worldwide issues, with more than 6.4 million passing happening yearly. An efficient survey presumed that pathology of the placenta, string, or layers is credited as a reason or contributory to stillbirth in 11% to 65% of cases in different orders, contingent upon the grouping utilized (3). The non-pharmacological techniques such as rest, music therapy, aromatherapy, relaxation therapy, acupuncture, acupressure, massage therapy, device-guided slow breathing, counselling, physical exercise, and yoga practice. That can potentially lower blood pressure among pregnant women with Hypertension and its complications. Mind-body therapy involves visualizing various mental images to facilitate relaxation and reduction in blood pressure (9).

Case Presentation

A primigravida 22 years female complained of a missing menstrual cycle and was diagnosed with Pregnancy positive with the help of a urinary pregnancy test (UPT). In the 13^th week, as per a routine follow-up for an antenatal ultrasound scan, reports show that there is a single live intrauterine gestation. Right uterine artery PI 2.89 and left uterine artery PI 2.10. Mean PI 2.49 and diagnosed UAD positive as a high-risk pregnancy. After a week time, the patient has given a blood sample for a thyroid profile, and reports revealed that TRI IODO THYRONINE (T3)-2.13 H and THYROXINE (T4) 21.9 H are in the higher range and a blood pressure marked as 150/100 mm/hg diagnosed as a pregnancy induced Hypertension.

Discussion

Yoga therapy is vital to minimize complications related to High-risk pregnancies such as Pregnancy-induced Hypertension (Figure 2). Here is a case study that shows an abnormal range of uterine artery PI (Right and Left), is used to screen high-risk pregnancies with the help of a Doppler scan at 13 weeks of gestational age. Patient blood pressure indicates a PIH, as well as patients diagnosed with the abnormal range of thyroid profile during gestational age. Yoga therapy was administered to the patient after 12 weeks of Gestation, including Asana, Pranayama, Meditation (MSRT), and Yogic Relaxation techniques (Deep relaxation technique) practises (Table 1) that have been researched based and validated in the previous study (11).

Table 1: Intervention (10): 3 days in a week from 2^nd trimester

Figure 2: An overview of High-Risk Pregnancy and Impact of Yoga.

At 13 week of gestational age, Physiological parameters (Table 2) such as blood pressure and antenatal scan, including artery PI, shows an abnormal range. In contrast, after the intervention, an 18-week scan shows a standard range of uterine artery PI, indicating proper blood circulation and nutrition to the growing fetus. There marked a significant change in psychological parameters Perceived stress scale (PSS), Depression anxiety assessment scale (DASS), and Sleep quality as shown in (Figure 3) and (Figure 4).

Table 2: Parameters

Figure 3: Physiological and Psychological parameters.

Figure 4: Uterine Artery Doppler.

At 36 weeks of gestational age, obstetric scan, Fetal biophysical profile Score shows a normal range for fetal posture and tone 2/2, Fetal movement 2/2, Fetal breathing movement 2/2, Quantitative amniotic fluid volume 2/2. Each of these five areas has consolidated a score of either 0 (abnormal) or 2 (average).

In total, Biophysical Profile (BPP) is 8/8, which indicates good health of the newborn; newborn weight is around 2.25 kg, and APGAR score is 8, 10, which shows good health since Preterm labour, premature baby, and low APGAR score is the complications of a high-risk pregnancy.

Conclusion

Yoga therapy is effective in managing high-risk pregnancies, such as Pregnancy-induced Hypertension, and Complications of high-risk Pregnancy, such as preterm labour (maternal health), low birth weight, Premature baby, and low APAGR score (Fetal health) in the newborn.

Yoga also impacts improving the quality of life during the gestational period and keeping stable psychological variables on the maternal side, such as anxiety and depression, as well as helping to cope with stress. Yoga is effective as a non-pharmacological treatment without any side effects during a high-risk pregnancy.

Authors’ contribution

RJ, SM, NR: Concept/design of the article, treatment and data acquisition; AK, S, S: Critical analysis and interpretation of data for the article and article-submission.

Informed consent

The study was verbally explained to the patient and written consent was signed by the patient.

Source of funding

None.

Conflict of interest

None.

Received Date: 20-03-23; Revised Date: 06-06-23
Accepted Date: 07-06-23

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