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Case Report | DOI: https://doi.org/10.31579/2690-8794/174
1 Assistant Professor, Department of Prasuti Tantra & Stri Roga, Government Ayurved college, Jabalpur
2 Professor, Department of Prasuti Tantra & Stri Roga, Parul university, Vadodara, Gujrat.
3 Professor, Department of Kaumarbhritya, Datta Meghe ayurved and medical college Nagpur.
*Corresponding Author: Sujata shamkuwar, Assistant Professor, Department of Prasuti Tantra & Stri Roga, Government Ayurved college, Jabalpur.
Citation: Sujata shamkuwar, Asokan V, Yogita Shrivas (2023), Effect of Yoga and Classicalmusic on Uterine Artery Indices, Clinical Medical Reviews and Reports, 5(4); DOI:10.31579/2690-8794/174
Copyright: © 2023, Ibrahim M. Hamouda. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 05 July 2023 | Accepted: 23 July 2023 | Published: 30 July 2023
Keywords: yoga; indian classical music; uterine artery indices; colour doppler
During antenatal period, the fetus and mother are connected through placenta, a structure that perform the functions of supplying nutrients to foetus, exchange of gases and elimination of waste through well maintained blood circulation. Thus, foetal health is dependent on this circulation. Any impairment in it can cause adverse effects on foetus. The present case study aimed at understanding the effect of yoga and Indian classical music on maternal and foetal health. Along with routine antenatal care, the patient was advised yoga exercises and listening to some Indian classical music ragas. Today, the effect of yoga and music has been examined on various physical and psychological dimensions of pregnant women. However, there are still sparse studies on the effect of yoga and music on the uterine artery indices as well as maternal and foetal complications. It was found that yoga and classical music resulted in improved uterine artery indices, foeto-maternal health and good foetal outcome.
The placenta is the thread of communication between mother and fetus. The placenta adapts itself to continuous vascular changes and differentiation so that efficient interaction between the utero-placental and foeto-placental circulation can be monitored and maintained so as to gain the optimum health of the foetus.
A condition where a foetus is unable to reach its optimum biological growth potential due to placental dysfunction, is known as foetal growth restriction (FGR) [1]. The foetus is entirely dependent on placental perfusion for oxygenation and nutrient supply. A healthy utero-placental circulation is a prerequisite for foetal growth and development and normal pregnancy outcome. If the blood flow is compromised, circulatory and metabolic needs of the foetus are not fulfilled which result in foetal growth restriction (FGR). The mother as well as child may have to face the consequences of placental dysfunction during and after labour. The pregnancies of mothers affected with placental dysfunction can be linked to peri-natal morbidity and mortality [2]. In the long run, there may be increased chances of obesity, metabolic and cardiovascular diseases in future adult hood [3].
In early pregnancy, it is very difficult to forecast which mother will develop pre-eclampsia and have a negative outcome because validated clinical tools or assays are not sufficiently sensitive and specific to predict these things. Systematic review for the uterine artery activity shows that in the second trimester, two Doppler ultrasound readings viz “Increased pulsatility index” and “bilateral notching” have quite reliable test performance in understanding which women are at low and high risk of developing severe pre-eclampsia [4].
Various studies on the physical and psychological dimensions of pregnant mothers are available. But very few studies have been done to know the effect of yoga in improving uterine artery function. The present study was performed to examine the effect of yoga and classical music on uterine artery Doppler indices, maternal, and foetal complications. The study evaluated the significance of yoga and classical music in alterations in venous and arterial Doppler waveform indices in compromised foetus through pulsatility index.
Case History
A 25 yrs. old female (OPD no.33911) visited OBS-GYNAE OPD on 03/08/2022 in Government Autonomous Ayurvedic College & Hospital, Jabalpur, MP. She had H/O amenorrhoea since 1month 19 days and complaints such as headache and vertigo. First of all, Urine pregnancy test was performed and it was found to be positive. On routine ANC profile the findings were HB-10Gm%, Blood group -AB +ve, HIV, VDRL, HBsAG -Negative, RBS-94, and Urine albumin & sugar-NIL. On examination Pulse was -88/min, BP was 130/80mm of Hg. The patient was treated with routine medication as per the trimester.
During first trimester she was advised some yogasana and classical music listening. The schedule is given ahead.
During, second trimester, she was advised Sukshma vyayama (light warm up exercises) followed by yogasana such as Ardhakatichakrasana, Ardhachakrasana, Trikonasana, vajrasana, Padmasana, Anulom-vilom and Bhramari pranayama, for 30 minutes according to her capacity. During, second trimester, Indian Classical music ragas viz. Bhupali, Kedar and Bageshri were prescribed for listening at their particular time in day/night.
In third trimester, Sukshma vyayama followed by yogasana viz Ardhakatichakrasana, Ardhachakrasana, Vajrasana, Malasana, Baddhakonasana and butterfly exercise were advised. Shawasana was advised in lateral position only, during 9th month. Anulom-vilom and Bhramari pranayama for 30 minutes were also advised according to her capacity. Indian classical music ragas like Bhupali, Kalyana and Malkauns at their prescribed time during day or night time were advised to listen.
| Date | Treatment | Follow- up |
1st visit 03/08/2022 (OPD NO. 33911) |
C/O – Amenorrhea since 1 month 19 days
|
LMP -14.6.2022 EDD -21.03.2023 Investigations Advised & findings at first visit Hemoglobin-10 gm% Blood Group -AB+ve HIV, VDRL, HbsAg -Negative Blood Sugar- 94 Urine Albumin -Nil Urine Sugar -Nil |
04/08/2022 Patient revisited OPD | C/O – Giddiness with fever H/O- 2 months Amenorrhea
Rx Tab. Folic acid -5 mg 1 OD Syp. Zymnet 2tsf BD Tab-Prexia BD | O/E –Afebrile P- 88/min BP-120/80mm of Hg Weight -50.6 kg P/A- Uterus –Not Palpable Investigations Advised & findings at first visit Hemoglobin-10 gm% Blood Group -AB+ve HIV, VDRL, HbsAg -Negative Blood Sugar- 94 Urine Albumin -Nil Urine Sugar -Nil |
| 10/08/2022 | C/O – Weakness H/O- 2 months Amenorrhea Rx Tab. Folic acid -5 mg 1 OD Tab. Prexia 1 BD | O/E Pulse- 84 beats per min/Regular B.P. -120/80 mm of Hg P/A – Soft,
Weight -50.6 kg Advice – Blood Sugar- were Thyroid Profile within (T3, T4, TSH) normal limits |
| 20/09/2022 | C/O – Headache, Vertigo Rx Tab. IFA 1BD Tab Calcium 1 BD Tab. MV/BC 1OD Promin protein Powder 2tsf BD with milk
| H/O- 3 Month + 6 Days O/E Pulse- 88 beats per min B.P. -130/84 mm of Hg Weight – 52 kg P/A -soft Uterus -just above pubic symphysis Adv-Complete blood Count (CBC)- was WNL USG Obs (NT Scan) |
| 10/10/2022 | C/O – No any Fresh complaint Rx Tab. IFA/ Calcium -1- OD Tab. Ecosprin -75 mg -1 -OD Tab. MV 1 BC -1- OD Spinpro protein Powder (2-0-2) Spoon with milk Syp -Foetosafe 2 BD (2-0-2) spoon
Adviced –Yogasana , Anulom-Vilom and Bhramari Pranayam, Raaga- Bhupali, Kedar, Bageshri
| H/O- 3 Month + 26 Days amenorrhoea O/E Pulse- 88 beats/min B.P. -120/70 mm of Hg Weight – 52 kg P/A-Uterus -14 wks -16 wks Foetal Heart Sound (FHS) -140/ min Lie -changing Colour Doppler Study - SLF with MGA 15 weeks+5 Days Increased PI with early compromised blood flow SLF with MGA 15 weeks+5 Day Adviced –Yogasana , Anulom-Vilom and Bhramari Pranayam, Raaga- Bhupali, Kedar, Bageshri |
19/10/2022
|
C/O – No Fresh complaints Rx Continued same treatment.
Adviced –Yogasana , Anulom-Vilom and Bhramari Pranayam, Raaga- Bhupali, Kedar, Bageshri
|
H/O- 4 Month + 5 Days O/E Pulse-- 88 beats per min B.P. -100/70 mm of Hg Weight. – 53 kg P/A-Uterus -16-18 wks- FHS -136/ min Lie -changing Target Scan-SLF with MGA-18weeks+/-2 weeks,CPR-1.3 S/O-early hypoxia |
| 16/11/2022 | C/O – Whole body itching Rx Continued same treatment. | H/O- 5 Months amenorrhoea O/E Pulse-- 88 beats/ min B.P. -130/90 mm of Hg Weight. – 55 kg P/A-Uterus -20-22 weeks FHS -144/ min ,reg Lie -changing Advised -LFT- was WNL CBC-Hb-10.9 Urine-Alb-sugar-Nil |
| 20/12/2022 | C/O – No Fresh complaint Rx Continued same treatment + Garbhapal Rasa 1 -BD | H/O- 6 Month + 6 Days O/E Pulse-- 88 beats per min B.P. -110/60 mm of Hg Weight. – 58 kg P/A-Uterus -24 wks FHS -136/ min Lie -changing |
01/02/2023 (OPD NO. 6139) | C/O – No any Fresh complaint Rx Continued same treatment. | H/O- 7 Month + 18 Days O/E Pulse-- 87 beats per min B.P. -120/70 mm of Hg Weight. – 59 kg P/A-Uterus -28-30 weeks FHS -144/ min ,Reg Lie -LOA Presentation-Cephalic |
| 14/02/2023 | C/O – No Fresh complaint Rx Stopped Ecosprin Rest continued same medicine
| H/O- 8 Months Amenorrhea O/E Pulse-- 82 beats per min B.P. -120/80 mm of Hg Weight. – 60 kg P/A-Uterus -32 wks FHS -136/ min Lie -LOA Presentation-Cephalic ADV-USG OBS for fetal well-being (Colour Doppler) |
22/02/2023 |
C/O – No Fresh complaints Rx
continue same medicine
| H/O- 8 Months +7 days amenorrhoea O/E Pulse-- 84 beats per min B.P. -120/70 mm of Hg Weight. – 61kg P/A-Uterus -32-34wks FHS -140/ min Lie -LOA, Presentation-Cephalic USG-SLF with MGA 35weeks+5 days Doppler study-Normal |
| 18/03/2023 | C/O-Pain in lower abdomen,low backache |
A full term female baby of weight 3.1 delivered by the patient vaginally on date 18/03/2023 at 11-29 Am |
Table 1: Follow-Up and Observations
To assess the foetal wellbeing basic parameters included were -biparietal diameter, head circumference, femur length, estimated foetal weight, foetal heart rate and colour Doppler study. It was found that yoga and classical music improved various foetal indices (BPD, HC, FL, HR, EFW) at the end of 35 weeks of gestation. The results show that yoga and music lead to
improvement in the left uterine artery function parameters (Systolic/diastolic ratio (S/D), Pulsatility index (PI) which was high during 15 weeks and 18 weeks and low CPR (cerebro-placental ratio), compromised blood flow and early hypoxia of foetus. The study also found that yoga and music leads to improved fetal-placental perfusion function indices. Also, during 1st visit the blood pressure was on higher side which was lowered after intervention.
USG findings of patient -
| 15weeks+5 days | 20weeks (anomaly scan) | 35 weeks. | |
| CRL | 10.4 cm | ||
| BPD | 3.2cm | 4.47cm(19wks+4D) | 8.9 cm(36 wks.) |
| HC | 11.4Cm | 15.5cm(18wks+3D) | 30.5(34wks) |
| AC | 9.9cm | 13.1cm(18wks+4D) | 29.6(33wks+4D) |
| FL | 1.9cm | 2.73cm(18wks+2D) | 7.4(38wks) |
| FHR | 156Bpm | 144 Bpm | 127 Bpm |
| Liquor | adequate | Adequate AFI-13 | Adequate AFI-9-10 |
| pl | Posterior, Grade 0 maturity | Posterior- Grade I maturity | Posterior- grade II maturity |
| EFW | 244 gm+/-36 gm | 2600+/-10% | |
doppler
| Date-30-09-2022 RT UT artery-PI-0.65,RI-0.47,SD-1.89 LT UT artery- PI-1.53, RI-0.77, SD-4.29 IMP-increased PI with early compromised blood flow | Date -17-10-2022 RT UT artery-PI-0.8, RI-0.5, LT UT artery- PI-1.6, RI-0.7, UMB ART-PI-1.2, RI-0.7 MCA-PI-0.8,RI-1.6 CPR-1.3 IMP-early hypoxia | Date-20-02-2023 RT UT artery PI-0.38, RI-0.31 LT UT artery PI-0.71,RI-0.49 MCA-PI-0.71,RI-0.49 IMP-Normal blood flow, no reversal flow,Doppler study normal |
Discussion
A thorough search for the literature regarding classical music, yogasana which are safe during pregnancy and their importance before and after conception was done. Similarly, its effects on foetal well-being were also studied. Other research journals, papers, books related to conception, pregnancy, stress, music, yoga and its effect, including effect on foetal velocimetry etc. were also explored.
Understanding the knowledge of obstetrics show that optimum foetal growth and normal pregnancy outcome require good utero-placental circulation. Uterine artery pulsatility index is a non-invasive method of assessing vascular resistance with the use of Doppler ultrasonography, commonly measured at 11-13+6 weeks to predict adverse pregnancy outcomes including hypertensive disorders and small-for-gestational age.5 Maternal health and normal placenta development are the factors that affect embryogenesis, foetal growth and survival in post natal period.6 .Early initiatives in prenatal period have shown enhancement in uterine perfusion and reduction in maternal and foetal complications. 7,8
Regular physical activity have been reported to prevent the occurrence of preeclampsia by facilitating placental development and vascularity, reducing oxidative stress and by Improving endothelial functions.9 Yoga can be a good alternative for future mothers as it increases micro circulation and increases fitness.
Some studies have linked higher stress with higher chances of spontaneous preterm labour and lower birth weight 10. Some evidence show the negative impact of stress on the (unborn) child’s cognitive and motor development 11 and emotional and behavioural facets. 12 .Yoga has demonstrated beneficial effects on anxiety and stress during anti natal period13,14,15 faster and simpler delivery, as well as increased foetal weight.16NatyaShastra, a Sanskrit treatise on performing arts mention that a raga have the capacity to evoke one of the nine emotions: sringara (love), hasya (happiness), adhuta (wonder and curiosity), vira (bravery), shanta (serenity), karuna (sorrow), raudra (anger), bhayanaka (fear) and vibhasta (disgust). The ragas are categorised accordingly.
Ragas have been assigned a specific time of the day on the basis that their very vibrations affect doshas Vata, Pitta and Kapha. Physiologically a particular dosha is dominant at a specific time in twenty-four-hour cycle. A study titled “An effect of Raga Therapy on our human body” published by the International Journal of Humanities and Social Science Research states that, a person suffering from a specific dosha disorder should be treated with ragas specified during that time as the ragas conciliate these doshas.
The ragas not only balance doshas but also affect the energy flow through nadis (astral nerves). SwaraShastra, an old Indian text, states that the 72 melakarta (parent) ragas control 72 vital nerves in the human body. According to quantum physics, we, as energy beings, vibrate at different frequencies. And certain frequencies are said to treat ailments
Various reviews highlight that during antenatal period music interventions also have a general anxiety alleviation effect 17, bring down blood pressure and depression score , improves sleep quality 18. It can be assumed in general that music create beneficial effects on the psychological health like perceived stress, anxiety and depressive symptoms during pregnancy 19
Study shows that use of low dose aspirin in foetal growth retardation show improvement in foetal growth 20. While other study contradicts the same. One study conducted with low dose aspirin and its association with fetal abnormalities didn’t show any significant difference between control and trial group. Thus, the use of aspirin does not surely guarantee positive foetal health changes. Also, there are safety concerns with extensive use of aspirin in obstetrics and reproductive medicine. Long term effects of LDA on cognitive and behavioural pattern of children is not known.
This case study was done to examine the impact of yoga and classical music on uterine artery function, as well as maternal and foetal complications. The results showed that yoga and music caused a significant change in Uterine artery PI in compromised blood flow of the foetus. Thus it can said that yoga and music therapy can be used as an additional tool in stress reduction and improving foetal growth through improved foeto-placental circulation.
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