ABSTRACT
Background and objectives Appropriate nutrition, along with the establishment of lactation, is of paramount importance for the feeding mother and the growing neonate. Asparagus racemosus, a common name for Shatavari, is a well-known herb that has been used as a galactagogue in traditional Indian culture. It is also referenced in Ayurvedic medicine. Despite multiple formulations available, palatability has been a concern always as Shatavari is very bitter. We have devised a palatable and nutritionally rich formulation of Shatavari with no artificial ingredients. To understand the efficacy, we have conducted this double-blind, prospective, randomized, controlled study to evaluate the effect of oral Shatavari formulation (Shavari Bar®) on breast milk output in postpartum women. Methods A prospective, randomized, parallel-group, double-blind, placebo-controlled study was conducted at two centers in women with gestational age 37 weeks or more who intended to breastfeed. Hundred and four women were screened, of which 78 were randomized to receive either bar containing Shatavari and oats (n=39, study) or an identical placebo bar (n=39, control). All 78 women completed the study, 61 delivered by a lower segment Caesarean section (LSCS), and 17 had a full-term normal vaginal delivery. Time to first noticeable breast fullness was measured and expressed milk volume measurements were done 72 hours after delivery or after consumption of four bars, whichever was later using a standardized breast pump. Comparison between the two groups was analyzed using a t-test. Results Demography and baseline data of patients enrolled were similar in the two groups. The mean total milk volume expressed was higher (p=0.008) with Shavari (64.74 ml) compared to placebo (49.69 ml). The time to breast fullness was shorter (p=0.024) with Shavari (30.49 hours) compared to placebo (38.09 hours). No adverse events were noted in either of the study groups. Global assessment of the satisfaction of mothers with lactation, the well-being of the child, taste, and ease of use was better in the treatment arm than in the placebo arm. Conclusion The use of the Shavari bar can be an effective option in postpartum women to establish early lactation and build confidence in breastfeeding along with nonpharmacological intervention.
ABSTRACT
BACKGROUND: Congenital urethrovaginal fistulas are rare, and all five reported cases have been associated with urogenital abnormalities. We describe a case of congenital urethrovaginal fistula with an imperforate hymen and no other urogenital abnormalities. CASE: A 25-year-old female sought medical advice regarding cyclical hematuria, dyspareunia, and infertility of four years' duration. Investigations disclosed a urethrovaginal fistula with an imperforate hymen. The patient was successfully treated with excision of the hymen and closure of the urethrovaginal fistula. CONCLUSION: In this instance, the diagnosis of congenital urethrovaginal fistula was delayed until adulthood because the presence of urinary incontinence, the usual presentation of a urethrovaginal fistula, was concealed by the imperforate hymen. We could find no previously reported case of urethrovaginal fistula with imperforate hymen.
