From an ayurvedic remedy to medical mayhem: A case report on herb induced liver injury as a cause of maternal sepsis and mortality

The existing regulations concerning the prescription, availability, and usage of ayurvedic and herbal supplements in India are insufficient. These supplements, which are sold in complex mixtures, often lack proper labelling and detailed information regarding their ingredients. Furthermore, there is a significant lack of reliable data regarding the consumption of these supplements during pregnancy. Maternal sepsis, as defined by the World Health Organization (WHO), refers to an infection that is acquired during pregnancy, delivery, or postabortion. The Roussel Uclaf Causality Assessment Method (RUCAM score) plays a crucial role in assessing the likelihood of the causality between a medication or herbal supplement and liver injury, aiding in determination of probability of drug induced liver injury (DILI) and herb induced liver injury (HILI). The Naranjo Adverse Drug Reaction Probability Scale is a recognized tool for evaluating the probability of a causal relationship between a specific medication and an adverse drug reaction (ADR), whereas the WHO casualty assessment scale is designed to assess the likelihood of a causal relationship between a drug and an adverse event. It is important to note that both prescribed and non-prescribed drugs, including pharmaceutical drugs, herbal supplements, ayurvedic medicines, dietary supplements, and other healthcare products, have the potential to cause DILI and HILI. In cases of suspected herbal hepatotoxicity, the condition is commonly characterized by the manifestation of either an idiosyncratic response, which can be further classified into metabolic and immunologic subtypes, or intrinsic responses. Unfortunately, there is limited available evidence regarding the potential harm caused by ayurvedic and herbal medications during pregnancy, and the connection to maternal sepsis is not well-documented.