SHREE LAKSHMI NARAYAN AYURVEDIC COLLEGE & HOSPITAL,
AMRITSAR
(Affiliated to –National Commission for Indian System of Medicines, New Delhi &
Guru Ravidas Ayurved University, Hoshiarpur)
DEPARTMENT- PRASUTI TANTRA EVAM STRI ROGA
Batch- 2021-2022
Certificate
This is to certify that, Mr. / Ms. , Enrolment
Number- has satisfactorily completed the Practicals Prasuti tantra evam stri
rog prescribed by the Guru Ravidas Ayurved University, Hoshiarpur as a part of the Third
Professional B.A.M.S. Course.
Examination Seat No.:
Sign. of Teacher Sign. of H.O.D.
Date of Examination-
Sign. Of Internal Examiner-
Sign. Of External Examiner-
JOURNAL /ACTIVITY BOOK
PRASUTI TANTRA EVAM STRI ROGA
(SUBJECT CODE : AyUG -PS)
Journal Cum Activity Book
DEPARTMENT OF PRASUTI TANTRA
EVAM STRI ROGA
SHREE LAKSHMI NARAYAN AYURVEDIC COLLEGE
& HOSPITAL, AMRITSAR
INDEX
Sr no Topic Date Page no
1 Garbhini Pareeksha -Antenatal case record
2 Prasava evum Sutika - Intrapartum & Postnatal record
3 Stree Roga - Gynaecological case record
4 Sthanika Upakrama- In-situ Treatment modalities
Section Minimum No of cases to be included as per the following
guidelines
A. Garbhini Pareeksha -Antenatal case record (5)
B. Prasava evum Sutika - Intrapartum & Postnatal record (10)
C. Stree Roga - Gynaecological case record (10)
D. Sthanika Upakrama- In-situ Treatment modalities (5)
Section A
GARBHINI PAREEKSHA-ANTENATAL CASE RECORD
Name:
Age:
Occupation:
Marital status:
Religion
OPD No:
IPD No:
DOA:
DOD:
Address:
Diagnosis:
Pradhana Vedana (Avadhiyukta) -
Anubandhi Vedana (Avadhiyukta) -
Vedana Vrittanta -
Poorva Vyadhi Vrittanta -
H/O: HTN / DM / Asthma / TB / HD / Epilepsy / STD / Nephritis / Rickets / Hepatitis
H/O Previous Surgeries:
Kula Vrittanta -
HTN / DM / Asthma / Colour Blindness / Twins / Congenital abnormalities / Bleeding disorders.
Chikitsa Vrittanta -
Vaiyaktika Vrittanta -
Diet: Appetite:
Sleep: Habits:
Bowels: Micturition:
Nature of Work:
Rajo Vrittanta -
Age of Menarche
Previous Menstrual cycle: Regular / Irregular
Prasava Vrittanta - G P A L D
Anartava Kala - L.M.P.
E.D.D.
P.O.G.
Poorva Prasava Vrittanata –
Order of Pregnancy Labour Mode of Puerperium Pregnancy Outcome
Delivery events events Delivery Live/Stillborn/Sex/Weight
Contraceptive History -
Duration:
Method used: Safe method / IUCD / OCP / Condoms / Others
General Examination -
Pallor: Height:
Odema: Weight:
Cyanosis : Pulse :
Icterus : Temperature
Lymph Nodes : Blood Pressure :
Breast: Respiratory Rate:
Nipples: Normal/Inverted
Samsthanika Pareeksha (Systemic Examination) -
RS :
CVS :
CNS :
Dashavidha Pareeksha
PRAVARA MADHYAMA AVARA
Prakriti
Vikruti
Sara
Samhanana
Pramana
Satmya Sarva rasa Madhyama rasa Ekarasa
Satwa
Ahara Shakti
Vyayam Shakti
Baala Madhyama Jeerna
Vaya
Antenatal Examination (P/A) -
Previous Scar / Any other Observation :
Abdominal Examination :
Fundal Height :
Lie :
Presentation :
FHS :
Vaginal Examination (P/V) -
Investigations -
Hb% : VDRL :
Blood Group &Rh : HbsAg :
RBS : HIV :
BT : CT :
Urine routine : TSH :
Platelet count :
Others :
USG -
Immunization -
Chikitsa –
Pathya- Apathya :
Follow up : Date:
Complaints :
Weight :
BP:
PR:
Oedema:
Examination :
Investigations
Treatment :
Signature of the Teacher Signature of the Student
SECTION B
PRASAVA AND SOOTIKA PAREEKSHA
(INTRAPARTUM & PUERPERAL RECORD)
Name:
Age:
Occupation:
Marital status:
Religion:
OPD No:
IPD No:
DOA:
DOD:
Address
Diagnosis:
Pradhana Vedana -
Aavi Pradurbhava :
Yoni Prasravana :
Garbhodaka Pravaha :
Anubandhi Vedana -
Vedana Vrittanta -
Poorva Vyadhi Vrittanta -
H/O: HTN / DM / Asthma / TB / HD / Epilepsy / STD / Nephritis / Rickets / Hepatitis
H/O Previous Surgeries :
Kula Vrittanta -
HTN / DM / Asthma / Colour Blindness / Twins / Congenital abnormalities / Bleeding disorders
VaiyaktikaVrittanta -
Diet : Appetite :
Sleep : Habits :
Bowels : Micturition :
Nature of Work :
Anartava Kala -
L.M.P : E.D.D: P.O.G:
Poorva Prasava Vrittanta (Obstetric History)
Order of Delivery Mode of Delivery Complications if any Pregnancy Outcome
Live/Stillborn/Sex/Weight
Contraceptive History -
Duration :
Method used : Safe method / IUCD / OCP / Condoms / Others
Investigations -
Hb% : HbsAg :
Blood Group &Rh : HIV :
RBS : VDRL :
BT : CT :
TSH : Platelet Count :
Urine routine :
USG
Others –
General Examination
Height : Pulse :
Weight Temperature
Blood Pressure: Respiration:
Samsthanika Pareeksha
RS :
CVS :
CNS :
LABOUR ASSESSMENT ( At Admission ) -
Udara Pareeksha (P/A) -
Fundal Height:
Presentation:
Uterine contractions:
FHS: bpm
Yoni Pareeksha (P/V) -
Cervical Dilatation:
Cervical Effacement:
Status of Membranes : Absent / Present
Time of Rupture :
Mode of rupture : Spontaneous / Artificial
Garbhodaka(Liquor ):
Amount: Less / Average /Excess
Colour: White / Yellow / Meconium Stained
Consistency: Thin / Thick
Station of Presenting Part:
Pelvic Assessment : Adequate/Not Adequate
Prasava paricharya / Intervention -
Induction of Labor : YES / NO
Bishop’s Score:
Cervix Score
0 1 2 3
Dilation Closed 1-2cm 3-4 >5cm
Effacement 0-30% 40-50% 60-70% >80%
Station -3 -2 -1, 0 +1, +2
Consistency Firm Medium Soft -
Position Posterior Mid Anterior
Bishop Score -
Date & Time Dilation of Effacement Consistency Position Station Subscore H
cervix
Mode of Assistance -
Vitapa Chedana (Episiotomy )
Prasava Samdansha Yantra (Forceps )
Nirvata Yantra (Ventouse )
Shastra Karma (LSCS )
Indication for Assistance –
Complications ( If Any) –
Prasava Kala:
Avyavrutta kala (1st Stage):
Garbha niskramana kala (2nd Stage):
Apara Patana Kala (3rd Stage):
Details of Nabhinaadi / Apara / Jarayu -
Nabhi Naadi Dairgya:
Anya Vikruti: Knot (True/False): Absent/Present
Apara Patana Prakara: Spontaneous / Manual Removal
Weight of Placenta:
Navajata Shishu Vivarana / Newborn Details -
Sex: M /F
Time of Birth:
APGAR score at 1 min:
APGAR score at 5 min: Weight:
Congenital anomalies if any :
Labour Details :
SOOTIKA PAREEKSHA (POSTNATAL EXAMINATION)
Days BP PR Temp Height of Uterus Lochia Perineum
Lactation (Involution) SFH
Day 1
Day 2
Day 3
Day 4
Day 5
Chikitsa -
Pathya & Apathya -
Advice on Contraception -
Condition on discharge -
Follow up -
Signature of Teacher Signature of the Student
SECTION C
STREEROGA PAREEKSHA
GYNAECOLOGICAL CASE RECORD
Name: OPD No:
Age: IPD No:
Occupation: DOA:
Marital status: DOD:
Address :
Religion :
Diagnosis:
Pradhana Vedana (Avadhiyukta) -
Anubandhi Vedana (Avadhiyukta) -
Vedana Vrittanta –
Poorva Vyadhi Vrittanta –
H/O: HTN / DM / Asthma / TB / HD / Epilepsy / STD / Nephritis / Rickets / Hepatitis
H/O Previous Surgeries :
Kula Vrittanta -
HTN / DM / Asthma / Colour Blindness / Twins / Congenital abnormalities / Bleeding disorders.
Vaiyaktika Vrittanta -
Diet : Appetite :
Sleep : Habits :
Bowel : Micturition :
Rajo Vrittanta –
Age of Menarche :
Menstrual cycle : Regular / Irregular
Rajah Kala (Duration ) :
Interval -
Pramana (Amount) :
Anubandhi Vedana :
Poorva Prasava Vrittanata -
Order of Delivery Pregnancy events Labour events Mode of Delivery Puerperium
Contraceptive History -
Duration :
Method used : Safe method / IUCD / OCP / Condoms / Others
(A) Ashta Sthana Pareeksha –
Nadi : Shabda [BP]
Mootra Sparsha (Temp) :
Mala Drik :
Jihwa Akriti (Built)
(B) Dashavidha Pareeksha -
Prakriti
Sara
Samhanana
Pramana
Satmya
Satwa
Ahara Shakti
Vyayama Shakti
Vaya
Ahara Shakti
Vyayama Shakti
Vaya
Samsthanika Pareeksha -
RS :
CVS :
CNS
Udara pareeksha / Abdominal Examination (P/A) -
Sthanika Pareeksha (Pelvic Examination) -
P/S :
P/V :
Prayogashala Pareeksha (Investigations) -
(C) Pancha lakshana nidana :
Nidana
Poorva roopa
Roopa
Samprapti
Upashaya / Anupashaya
Upadrava
Sadhyasadhyata
Samprapti Ghataka
Dosha :
Dushya :
Dhatu :
Upadhatu :
Mala :
Agni :
Ama :
Srotas :
Udbhava Sthana :
Sanchara Sthana :
Vyakta Sthana :
Adhistana :
Rogamarga
Srotovaigunya - Atipravrutti / Sanga / Vimargagamana / Sira granthi
Vyavacchedaka Nidana ( Differential Diagnosis ) -
Vyadhi Viniscchaya (Final Diagnosis ) –
Chikitsa Sootra ( Line of Treatment) -
Chikitsa ( Treatment ) –
Shodhana : Vamana / Virechana / Vasti /Nasya / Raktamokshana
Shamana :
Sthanika upakrama :
Follow up :
Signature of Teacher Signature of the Student
SECTION D
STHANIKA UPAKRAMA
IN SITU TREATMENT RECORD
Name: OPD No:
Age: IPD No:
Occupation: DOA:
Marital status: DOD:
Religion: Address :
Diagnosis:
Name of Upakrama -
Poorva Karma -
Pradhana Karma
Paschat Karma
Upadrava if any / management –
Observation:
Day Date Name of sthanika upkrama Sign of Sign of
Student teacher
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.