NEED OF STUDY: According to the WHO, anaemia affects 14% of pregnant women in developed and 51% in developing countries. It is painful to mention that India accounts for almost 80% of maternal fatalities in South Asia owing to anaemia. Anaemia during pregnancy has been linked to poor maternal and child health, as well as a higher risk of maternal and perinatal mortality. Fatigue, poor work capacity, increased risk of cardiac disease and mortality are all unfavourable health implications for the mother. Preterm birth and low birth weight babies are associated to anaemia in pregnancy. It is also associated with increased risk of intrauterine deaths, low APGAR score and intrauterine growth restriction (IUGR).[10] Anaemia is commonly due to dietary deficiency (nutrition, iron, folic acid, iodine and other micronutrients) or infections.[11] Acharya Charaka has said that Raktadi dhatus get vitiated by Doshas, mainly by Pitta dosha and disease like Pandu appear. There is no direct formulations available for the management of Garbhini Pandu in Ayurveda Samhitas. The line of treatment in Pandu is Shodhana, but it is contraindicated during pregnancy. Therefore, appropriate Shamana Chikitsa has to be adopted. On the basis of Pandughnata (antianaemic), Preenana (nourishing) and Raktaprasadana (blood toner) properties Punarnava Mandura is found useful for the management of all types of Pandu. Hence to prevent various complications of anaemia in pregnancy, to provide a safe management to the pregnant lady and to study the efficacy of indigenous compound this research work is undertaken. 

AIM: ï‚· To assess the role of Punarnava Mandura with and without Shatavari Avaleha in the management of Garbhini Pandu. 

OBJECTIVES: Primary Objectives: • To assess and compare the efficacy of Punarnava Mandura with and without Shatavari Avaleha in the management of Garbhini Pandu. Secondary Objectives: 1. To assess the improvement in quality of life. 2. To assess the improvement in associated symptoms of Garbhini pandu such as Shrama (fatigue), Panduta (pallor), Daurbalya (general weakness), Shwasa (dyspnea), Hridspandana (palpitations), Aruchi (anorexia), Akshikuta Shoth (periorbital edema), Pindikodveshthana (leg cramps), Bhrama (giddiness). 

HYPOTHESIS: 

ï‚· NULL HYPOTHESIS (H0): There is no difference in the efficacy of Punarnava Mandura with and without Shatavari Avaleha in the management of Garbhini Pandu.

ï‚· ALTERNATIVE HYPOTHESIS (H1): There is significant difference in the efficacy of Punarnava Mandura with and without Shatavari Avaleha in the management of Garbhini Pandu. 

ï‚· RESEARCH QUESTION: Is there significant difference in the efficacy of Punarnava Mandura with and without Shatavari Avaleha in the management of Garbhini Pandu? 

ASSESSMENT CRITERIA: During the trial and follow up study the patients will be assessed on the basis of following parameters before and after the treatment. ï‚· Shrama (fatigue), Panduta (pallor), Daurbalya (general weakness), Shwasa (dyspnea), Hridspandana (palpitations), Aruchi (anorexia), Akshikuta Shoth (periorbital edema), Pindikodveshthana (leg cramps), Bhrama (giddiness). ï‚· Complete blood count (CBC), Haemoglobin percentage (Hb%), Serum iron, Total iron binding capacity (TIBC), Serum ferritin. 

LABORATORY INVESTIGATIONS: Before Treatment: • Complete blood count (CBC) • Peripheral blood smear (PBS) • Serum Iron • Total iron binding capacity (TIBC) Serum Ferritin • RFT - Blood Urea, Serum Creatinine • LFT - Total Serum Bilirubin, Serum Albumin, Total Protein • Other routine ANC investigations:  Blood group with Rhesus factor (ABO RH)  Human Immunodeficiency Virus (HIV)  Veneral disease research laboratory (VDRL)  Hepatitis B Surface Antigen (HbsAg) • Ultrasonography (USG) for fetal well being During Treatment: Haemoglobin After Treatment: ï‚· Complete blood count (CBC) ï‚· Serum iron ï‚· Total iron binding capacity (TIBC) ï‚· Serum ferritin