RPOC and Homoeopathy

RPOC AND HOMOEOPATHY
(A Practical Study)
Dr. Sudha Bala
CMO, Homoeopathy
Directorate of ISM and Homoeopathy
Delhi Government
Key words: Homoeopathy/RPOC/clinical study
DECLARATION:
I, Dr. Sudha Bala, hereby state that the following is an original work done by me. All the
facts, figures, names, designations and terms mentioned in this report pertain to the
timeline in which the study was carried out, i.e., from August 2010 to April 2013.
INTRODUCTION:
Retained product of conception (RPOC) refers to the persistence of placental and/or

fetal tissue in the uterus following delivery, termination of pregnancy or a miscarriage. The
presence of RPOC after a spontaneous pregnancy loss distinguishes an incomplete from a
complete miscarriage. RPOC can complicate ~ 1% of all pregnancies.
The characteristic clinical manifestations of RPOC include one or more of the following:
uterine bleeding, pelvic pain, fever and/or uterine tenderness. These clinical findings are
nonspecific; moreover, it is normal to have some post abortal bleeding and discomfort.
Uterine bleeding Women routinely have some uterine bleeding after a miscarriage or
pregnancy termination, so it can be difficult to distinguish normal from abnormal bleeding. A
reasonable approach is to assume that bleeding is probably abnormal if it is heavy (i.e., has
the potential to result in anemia [passage of large clots or flow that is significantly greater
than menses, or not diminishing over time) or prolonged (i.e., lasting longer than three
weeks).
INVESTIGATIONS:
Ultrasound is typically the first-line investigation in suspected RPOC. It may demonstrate a
variable amount of echogenic or heterogeneous material within the endometrial cavity. The
presence of vascularity within this supports the diagnosis, and helps to differentiate it from
intrauterine blood clot. Calcifications may be present. RPOC can be suspected on ultrasound
if the endometrial thickness is > 5 mm following dilatation and curettage or spontaneous
abortion.
MRI- Retained products of conception can appear on MR imaging as an intracavitary uterine
soft-tissue mass with variable amounts of enhancing tissue and variable degrees of
myometrial thinning and obliteration of the junctional zone.
RISKS:
The risks involved from the conventional treatment procedure includes excessive bleeding,
injury to nearby areas (tissue or organs), surgical or wound infection, blood clots in the legs
and lungs, allergic reaction to drugs or anaesthesia, breathing difficulties during or following
the general anaesthesia. The likelihood of complications increases in patients who are
overweight or obese, heavy smokers and those with medical problems such as diabetes or
chronic lung conditions that are not well controlled. Very occasionally (1 in 300 cases),
unintentionally a small hole in the uterus is made. There may still be some retained
products of conception (2% of cases). They aim to remove the products properly during the
operation but it is important to be very gentle and occasionally the uterus may not be
completely emptied.
It should be the aim of the physician to treat the individual rather than the particular
disease condition. Hence there appears to be a general need for medications with good
efficacy in the treatment of this disorder. Homoeopathy approaches the patient individually
and considers the patient as a whole and treats accordingly. Homoeopathy with its unique
principle and a wide range of remedies has a better role in the treatment of RPOC, which
needs to be scientifically investigated.
OBJECTIVE:
This study is done with the viewpoint of studying the Homoeopathic Management of this
disease condition which is least dealt along with statistical data. So an effort is being made
to reiterate the role of Homoeopathic treatment in the individuals suffering from RPOC. This
study is a contribution towards the growing trend of evidence based medicine. It also
emphasizes on importance of conservative management, when properly applied, over more
invasive, expensive and riskier therapeutic options.
CLINICAL STUDY:
CASES: The present study was undertaken on patients attending Homoeopathic Unit,
Sanjay Gandhi Hospital, Mangolpuri, Delhi with integration of Dept. of OBG & Dept. of
Radiodiagnosis. About 46 Cases were taken for study. This study was done for a period
between August 2010 to April 2013.
For this each and every patient suffering from the complications of RPOC/Incomplete
abortion, coming directly to homoeopathic dept, referred cases from the Dept. of OBG of the
hospital and cases from maternity centres, Mangolpuri are all included. The cases are being
evaluated by the gynaecologists and ultrasonography was done before and after treatment.
No other medication was given during homoeopathic treatment.
The basis for prescription was according to the totality of the symptoms. The prescribing
totality was made depending upon the presentation of the cases. Selection of remedy was
done on the basis of prescribing totality, with importance given to physical generals,
characteristic particulars, past history and family history. Mental generals are included if
they are very striking.
Follow ups are continued up to two normal menstrual cycles.
OBSERVATION AND RESULTS:
This section contains the description of the data collected from 46 cases using tables and
charts. Description and inferential statistics are used in the analysis and interpretations of
the findings, which focus on the results, and the objectives of the study conducted on RPOC.
1. Type of Cases reported
S.n Type of cases No.of cases

o
1. D & C Failures 6
2. Medical treatment failures 38
3. Complications after full term 2
2. Distribution of cases in relation with results of treatment

S.n RESULTS NO.OF CASES
o
1. Recovered (total evacuation) 27
2. Improved (symptomatic 14
relief)
3. Not Improved 4
4. Did not report back 1
3. Treatment Response Time:
S. No. Response Time No. of cases

1. 2-8 days 31
2. 10-20 days 10
4. Indicated Remedies with potencies

S.no Medications given No. of cases
1. Sabina 30, 200 45
2. Sepia 30, 200 27
3. Cantharis 30 2
4. Ferrum phos 6X 3
5. Arnica 200 8
6. Nat. Mur 200, 1 M 2
7. China 30 14
DISCUSSION:
The present study was carried out in 46 cases that satisfied the objectives. The patients
generally have belonged to the lower socioeconomic group, except three patients were the
nurses employed in the hospital itself, and one patient being a gyneocologist herself.
The outcome of the study is briefly discussed below.
59% of patients showed complete resolution, and RPOC was shown to be
completely evacuated in follow-up USG. Another 30% patients reported
symptomatic relief, with normal menstruation being resumed on follow-up till 2
cycles. Hence 89% patients were successfully managed with homoeopathic
conservative treatment alone. This avoids the inevitable surgical intervention that
they would have otherwise required, which would have been not only significantly
riskier, invasive but also an economic burden.
The scanned reports of patients involved in this study are available with this presentation.
CONCLUSION:
Homoeopathic Materia Medica and other literatures show very less evidence regarding
RPOC. So, it was a modest effort on my part to find the role of homoeopathic medicines in
the treatment of RPOC.
This study suggests that homoeopathy can be successfully used to manage majority of such
cases, thereby helping the patients as well as the government in saving the additional
financial burden of avoidable surgeries. It also helps in distributing the workload from other
departments, providing better acceptance and integration of homoeopathic units in medical
set-up.
This study can be made more comprehensive with more extensive use of available
investigations in follow-up like regular CBC, USG and MRI in integration with gynaecologists.
Further collaborative research studies with well-designed protocols are required to be
undertaken for increasing the use of homoeopathy in MCH.
REFERENCES:
1. Web references .www.uptodate.com, www.wikipedia.com
2. ALLEN.H.C, Key Notes and Characteristics with Comparisons of some of the Leading
Remedies of the Materia Medica with Bowel Nosodes, New Delhi, B.Jain Publishers Pvt. Ltd.,
8th Reprint Edition 1996.
3. BOERICKE, WILLIAM, A Manual of Homoeopathic Materia Medica and Repertory, New
Delhi, B.Jain Publishers Pvt. Ltd., Reprint Edition 1996.
4. Other relevant literatures etc.
Acknowledgments:
Presentation prepared by:
Dr. Ram Kumar, SMO (H), Baba Saheb Ambedkar Hospital, Directorate of ISM and
Homoeopathy
Dr. Priyamvada, MBBS
Assistance and Technical help provided by:
Dr. Punita Mahajan, Dr. Anjali, Dr. Ashu Gupta, Dr. Poonam - Dept. of OBG, Sanjay
Gandhi Memorial Hospital, Mangolpuri, Delhi
Dr. Dheeraj, Dr. Ravinder Kaur - Maternity Center, A-Block, Mangolpuri, Delhi
Dr. Anju Bhatia - Dept. of Radiodiagnosis, Sanjay Gandhi Memorial Hospital,

Mangolpuri, Delhi

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Key words: Homoeopathy/RPOC/clinical study

Retained product of conception (RPOC) refers to the persistence of placental and/or

1. Type of Cases reported

S.n Type of cases No.of cases

2. Distribution of cases in relation with results of treatment

3. Treatment Response Time:

S. No. Response Time No. of cases

4. Indicated Remedies with potencies

4. Other relevant literatures etc.

Presentation prepared by:

Dr. Priyamvada, MBBS

Assistance and Technical help provided by:

Dr. Anju Bhatia - Dept. of Radiodiagnosis, Sanjay Gandhi Memorial Hospital,

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