Breech Presentation

  • Effectiveness and Safety of Acupuncture and Moxibustion in Pregnant Women with Noncephalic Presentation: An Overview of Systematic Reviews.  Abstract   Breech presentation at the time of delivery is 3.8-4%. Fetuses that maintain a noncephalic presentation beyond 32 weeks will have a lower probability of spontaneous version before labor. Given the increasing interest in exploring the use of complementary medicine during pregnancy and childbirth, the moxibustion technique, a type of traditional Chinese medicine, could be another option to try turning a breech baby into a cephalic presentation.  Objectives:  To review the evidence from systematic reviews (SR) on the efficacy and safety of acupuncture and moxibustion in pregnant women with noncephalic presentation.   Main Results:  Our SR synthesizes the results from five clinical trials on pregnant women with a singleton noncephalic presentation. There is evidence that moxibustion reduces the number of noncephalic presentations at the time of birth compared with no treatment. The adverse effects that acupuncture and moxibustion can cause seem to be irrelevant. Most SRs agree that there are no adverse effects directly related to acupuncture and moxibustion.  Conclusions:  Even though the results obtained are positive and the five reviews conclude that moxibustion reduces the number of noncephalic presentations at birth (alone or combined with postural techniques or acupuncture), there is considerable heterogeneity between them. Better methodologically designed studies are required in the future to reaffirm this conclusion.   Miranda-Garcia M Domingo Gómez C, Molinet-Coll C, Nishishinya B5, Allaoui I Gómez Roig MD Goberna-Tricas J
  • A systematic review of randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on moxibustion, acupuncture or any other acupoint stimulating methods for breech presentation in pregnant women evaluated the efficacy and safety of moxibustion and other acupoint stimulations to treat breech presentation.A meta-analysis which included:all searches in PubMed, the Cochrane Library (2008 Issue 2), China National Knowledge Information (CNKI), Chinese Scientific Journal Database (VIP) and WanFang Database ended in July 2008. Two authors extracted and analyzed the data independently. Results Ten RCTs involving 2090 participants and seven CCTs involving 1409 participants were included in the present study.   Meta-analysis showed significant differences between moxibustion and no treatment (RR 1.35, 95% CI 1.20 to 1.51; 3 RCTs).   Comparison between moxibustion and knee-chest position did not show significant differences (RR 1.30, 95% CI 0.95 to 1.79; 3 RCTs).   Moxibustion plus other therapeutic methods showed significant beneficial effects (RR 1.36, 95% CI 1.21 to 1.54; 2 RCTs).   Laser stimulation was more effective than assuming the knee-chest position plus pelvis rotating.  Moxibustion was more effective than no treatment (RR 1.29, 95% CI 1.17 to 1.42; 2 CCTs) but was not more effective than the knee-chest position treatment (RR 1.22, 95% CI 1.11 to 1.34; 2 CCTs).  Laser stimulation at Zhiyin (BL-67) was more effective than the knee-chest position treatment (RR 1.30, 95% CI 1.10 to 1.54; 2 CCTs).  Conclusion: Moxibustion, acupuncture and laser acupoint stimulation tend to be effective in the correction of breech presentation.   Li X., Hu J, Wang X, Zhang H. and Liu J. (2009) Moxibustion and other acupuncture point stimulation methods to treat breech presentation: a systematic review of clinical trials. Chinese Medicine, 4:4. doi:10.1186/1749-8546-4-4
  • A study of the effectiveness and cost of moxibustion for breech presentation compared to standard care found that the percentage of breech presentations after moxibustion was 24.5% compared to 42% for standard care, and that if only 10% of women opted for moxibustion it would overall be more effective and less costly than standard care.  The effectiveness and cost-effectiveness of Breech Version Acumoxa compared to standard care to correct breech presentation. Focus Altern Complement Ther, 2006; 11:05.
  • Randomised controlled trial evaluated the efficacy and safety of moxibustion to correct breech presentation on Zhiyin BL-67 (the acupuncture point at the little toe).130 women with a breech presentation and having their first baby (primigravidas) at 33 weeks gestation received moxibustion to Zhiyin BL-67 while 130 women, also with a breech presentation and who were also primigravidas, received no intervention.  The moxibustion was administered for seven days. Women were then assessed and a further seven days of moxibustion treatment given if the baby’s position had not changed.  Outcomes were measured in terms of foetal movements, as counted by the mother for one hour each day for one week, and the number of cephalic presentations both at 35 weeks gestation and at delivery.  At 35 weeks gestation 75.4% in the intervention group had changed to cephalic (47.7% in the control). In terms of foetal movement the moxibustion group experienced a greater number of movements (a mean of 48.45 compared to the control group with a mean of 35.35).  Conclusion: in prigravidas at 33 weeks gestation with breech presentation, moxibustion treatment for one to two weeks at Zhiyin BL-67 increased foetal activity during the treatment period and cephalic presentation at 35 weeks and at delivery.   Cardini F, Weixin H. Moxibustion for correction of breech presentation. Journal of American Medical Association 1998; 280:1580-1584.
  • A study has evaluated the effects of acupuncture and moxibustion on the behaviour of breech foetuses.Women were treated by stimulating Zhiyin BL-67 twice a week for 20 minutes. Fourteen cases were treated using both acupuncture and moxibustion, 15 cases by moxibustion and ten cases by acupuncture only. In 56% of cases, foetal position converted from breech to cephalic (80% success rate for moxibustion, 28% for acupuncture, 57% for acupuncture plus moxibustion).  Conversion, on average, was achieved after three sessions. During the process of stimulation, it was found that foetal movements were reduced by both acupuncture plus moxibustion and moxibustion alone, and that foetal heart rate was reduced only by acupuncture plus moxibustion in combination.  Effects of three different stimulations (acupuncture, moxibustion, acupuncture plus moxibustion) of BL-67 acupoint at small toe on foetal behaviour of breech presentation. Am J Chin Med. 2007; 35(1):27-33.
  • An Italian study into breech presentation compared 112 randomly selected women who were given acupuncture and moxibustion at Zhiyin BL-67, with 114 women who were simply observed. All were at 33-35 weeks of gestation. The proportion of caesarean sections required in the acupuncture treatment group was significantly lower than in the control group (52.3% versus 66.7%).Journal of Maternal-Fetal and Neonatal Medicine, 15; 4:247-252.
  • A study carried out in Croatia compared the outcome of 34 pregnant women with breech presentation treated by manual needling of Zhiyin BL-67 (with deqi), and 33 similar women not treated by acupuncture as a control. Acupuncture was given from 34 weeks, each session lasting 30 minutes, 2 sessions a week. The rate of successful conversion to vertex presentation (verified by ultrasonography) was 76.4% in the acupuncture group, and 45.4% in the control group. A mean of 6 acupuncture treatments was needed, and acupuncture was discontinued on successful outcome, or after 38 weeks if unsuccessful.Fetal Diagnosis and Therapy, 2003, Vol.18, No.6.
  • A systematic review from Holland has concluded that acupuncture-type interventions (moxibustion, acupuncture, or electro-acupuncture) on Zhiyin BL-67 are effective in correcting breech presentation, compared with expectant management.Of the 65 citations retrieved from various databases, six RCTs and three cohort studies fulfilled the reviewers’ inclusion criteria. In the RCTs the pooled proportion of breech presentations was 34% following treatment versus 66% in the control group. The pooled proportion in the cohort studies was 15% versus 36%. Including all studies, the proportion of breech presentations was 28% following treatment versus 56% for the control group.  Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: a systematic review. Complement Ther Med 2008 Apr 16(2):92-100.
  • An Italian obstetrician has carried out a study into the application of moxibustion at Zhiyin BL-67 for the treatment of breech presentation in pregnancy. Francesco Cardini and Huang Weixin divided 130 women (in the 33rd week of their first pregnancy) in two Chinese hospitals into two groups. Those treated with moxibustion (for 7 consecutive days, with seven more if needed) experienced greater foetal movement and had significantly more normal (cephalic) births than untreated women.The Journal of the American Medical Association 1998; 280.
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