Moxibustion for cephalic version: A feasibility randomised controlled trial

School of Biomedical and Health Sciences, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW 2751, Australia.
BMC Complementary and Alternative Medicine (Impact Factor: 2.02). 09/2011; 11(1):81. DOI: 10.1186/1472-6882-11-81
Source: PubMed


Moxibustion (a type of Chinese medicine which involves burning a herb close to the skin) has been used to correct a breech presentation. Evidence of effectiveness and safety from systematic reviews is encouraging although significant heterogeneity has been found among trials. We assessed the feasibility of conducting a randomised controlled trial of moxibustion plus usual care compared with usual care to promote cephalic version in women with a breech presentation, and examined the views of women and health care providers towards implementing a trial within an Australian context.
The study was undertaken at a public hospital in Newcastle, New South Wales, Australia. Women at 34-36.5 weeks of gestation with a singleton breech presentation (confirmed by ultrasound), were randomised to moxibustion plus usual care or usual care alone. The intervention was administered over 10 days. Clinical outcomes included cephalic presentation at birth, the need for ECV, mode of birth; perinatal morbidity and mortality, and maternal complications. Feasibility outcomes included: recruitment rate, acceptability, compliance and a sample size for a future study. Interviews were conducted with 19 midwives and obstetricians to examine the acceptability of moxibustion, and views on the trial.
Twenty women were randomised to the trial. Fifty one percent of women approached accepted randomisation to the trial. A trend towards an increase in cephalic version at delivery (RR 5.0; 95% CI 0.7-35.5) was found for women receiving moxibustion compared with usual care. There was also a trend towards greater success with version following ECV. Two babies were admitted to the neonatal unit from the moxibustion group. Compliance with the moxibustion protocol was acceptable with no reported side effects. Clinicians expressed the need for research to establish the safety and efficacy of moxibustion, and support for the intervention was given to increase women's choices, and explore opportunities to normalise birth. The sample size for a future trial is estimated to be 381 women.
Our findings should be interpreted with caution as the study was underpowered to detect statistical differences between groups. Acceptance by women and health professionals towards moxibustion suggest further research is warranted.
Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000985280.

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    • "The other one did not provide any information of followup [22]. When it comes to selective reporting bias, the trial protocol was available for two trials [19] [21]; however, the other five studies failed to provide it [16–18, 20, 22]. Of those five trans, three studies "
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    ABSTRACT: Objectives. This study aims to assess the effectiveness and safety of moxibustion for the correction of nonvertex presentation. Methods. Records without language restrictions were searched up to February 2013 for randomized controlled trials (RCTs) comparing moxibustion with other therapies in women with a singleton nonvertex presentation. Cochrane risk of bias criteria were used to assess the methodological quality of the trials. Results. Seven of 392 potentially relevant studies met the inclusion criteria. When moxibustion was compared with other interventions, a meta-analysis revealed a significant difference in favor of moxibustion on the correction of nonvertex presentation at delivery (risk ratio (RR) 1.29, 95% confidence interval (CI) 1.12 to 1.49, and I (2) = 0). The same findings applied to the cephalic presentation after cessation of treatment (RR 1.36, 95% CI 1.08 to 1.71, and I (2) = 80%). A subgroup analysis that excluded two trials with a high risk of bias also indicated favorable effects (RR 1.63, 95% CI 1.42 to 1.86, and I (2) = 0%). With respect to safety, moxibustion resulted in decreased use of oxytocin. Conclusion. Our systematic review and meta-analysis suggested that moxibustion may be an effective treatment for the correction of nonvertex presentation. Moreover, moxibustion might reduce the need for oxytocin.
    Evidence-based Complementary and Alternative Medicine 09/2013; 2013:241027. DOI:10.1155/2013/241027 · 1.88 Impact Factor
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    ABSTRACT: There is some evidence to suggest that moxibustion may be useful for turning babies from breech presentation (bottom first) to cephalic presentation (head first) for labour when used with either acupuncture or postural techniques of knee to chest or lifting buttocks while lying on the side. Breech presentation of babies is common in the second trimester of pregnancy but most babies turn themselves before the onset of labour; some do not. A baby coming bottom first can have more difficulty being born, which causes trauma to the mother. A vaginal birth has to be planned or a caesarean section may be suggested. Moxibustion is a type of Chinese medicine that may be helpful in turning a breech baby. It involves burning a herb close to the skin at an acupuncture point on the little toe to produce a warming sensation. This review found eight randomised controlled trials involving 1346 women. Women randomly assigned to moxibustion had daily to twice weekly treatment at between 28 and 37 weeks. In one trial adverse events relating to treatment included an unpleasant odour (with or without throat irritation), nausea and abdominal pain from contractions. The included trials were of moderate methodological quality, sample sizes in some of the studies were small, how the treatment was applied differed and reporting was limited. While the results were combined they should be interpreted with caution due to the differences in the included studies. More evidence is needed concerning the benefits and safety of moxibustion.
    Cochrane database of systematic reviews (Online) 05/2012; 5(5):CD003928. DOI:10.1002/14651858.CD003928.pub3 · 6.03 Impact Factor
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    ABSTRACT: Midwives at West Middlesex NHS Trust (WMUH) have been trained in the use of moxibustion to turn a breech presentation. This paper informs the reader of this service, how it was implemented, the audit and importance of maintaining accurate data as well as the resulting changes to the service. Moxibustion appears to be a safe, easy and cost effective way to promote cephalic presentation and is offered prior to external cephalic version (ECV).
    The practising midwife 09/2012; 15(8):S3-4.
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