Article

Acupuncture plus moxibustion to resolve breech presentation: A randomized controlled study

Taylor & Francis
The Journal of Maternal-Fetal & Neonatal Medicine
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Abstract

In many Western countries breech presentation is an indication for elective Cesarean section. In order to correct fetal presentation, the stimulation of the acupoint BL67 by moxibustion, acupuncture or both has been proposed. Since no studies had previously been carried out on Western populations, pregnant Italian women at 33-35 weeks gestational age carrying a fetus in breech presentation were enrolled in a randomized, controlled trial involving an active BL67 point stimulation and an observation group. A total of 240 women at 33-35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. Bilateral acupuncture plus moxibustion was applied at the BL67 acupoint (Zhiyin). The primary outcome of the study was fetal presentation at delivery. Fourteen cases dropped out. The final analysis was thus made on 226 cases, 114 randomized to observation and 112 to acupuncture plus moxibustion. At delivery, the proportion of cephalic version was lower in the observation group (36.7%) than in the active-treatment group (53.6 %) (p = 0.01). Hence, the proportion of Cesarean sections indicated for breech presentation was significantly lower in the treatment group than in the observation group (52.3% vs. 66.7%, p = 0.03). Acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.

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... A specific acupoint called "BL67 Zhiyin" has been used for moxibustion that is at the outer corner of the little toenail [20,25]. Although there is a theoretical risk of preterm contractions especially after 35 weeks of gestation, the procedure can be applied between 32-37 weeks [5,6,[26][27][28]. Meta-analysis and randomized controlled studies highlighted that moxibustion is an effective and safe method when used to promote spontaneous version [6,[24][25][26]. ...
... Although there is a theoretical risk of preterm contractions especially after 35 weeks of gestation, the procedure can be applied between 32-37 weeks [5,6,[26][27][28]. Meta-analysis and randomized controlled studies highlighted that moxibustion is an effective and safe method when used to promote spontaneous version [6,[24][25][26]. Still, there are controversial reports about its effectiveness in the literature on moxibustion [5,27,[29][30][31][32]. ...
... To date, controversial findings have been reported in the literature. Some researchers claimed that moxibustion increases the vertex presentation rates, whereas others reported that moxibustion has no effect [20,26,27,30,35]. In our study, there was no statistical difference in presentation rates between the control and moxibustion groups immediately after moxibustion sessions. ...
Article
Objective To evaluate the moxibustion for turning fetuses from breech to vertex presentation. Materials and Methods This was a single-center prospective study. All pregnant women carrying a fetus in breech presentation between the 32 and 35 gestational weeks were offered moxibustion application. The primary outcomes were vertex presentation at 37 weeks of gestation, vertex presentation at birth, and vaginal birth rates. A secondary analysis was performed to understand the effect of parity, type of breech presentation, body mass index (BMI), placental location, gender, and fetal birth weight on the presentation at birth. Results There were 63 cases in the study group and 245 cases in the control group. The rate of vertex presentation at term was found to be higher in the moxibustion group compared to controls (66.7 vs. 48.2%, p=0.022). There were 45 (71.4%) and 131 (53.5%) fetuses with vertex presentation at birth in the study and control groups, respectively (p=0.020). Overall, vaginal delivery rate was higher in the study group (50.8 vs. 37.1%, p=0.048). Multiparity and higher birth weight were associated with increased rates of vertex presentation in the moxibustion and control groups. Conclusion Moxibustion application increased the rate of vertex presentation at birth and also vaginal delivery rate compared with expectant management. Offering moxibustion between the 32nd and 36th week of gestation may provide women with a singleton fetus in breech presentation an opportunity for a vaginal birth.
... The size of the study populations ranged from 20 to 406 persons. The 16 studies included a total of 2555 participants; eight studies included participants from China [10,11,[19][20][21][22][23][24], two studies included participants from Italy [25,26], and the others included participants from France [27], Australia [28], Switzerland [29], Croatia [17], Denmark [16], and Spain [15]. Most studies were published in English (56.3%); others were published in Chinese (37.5%) and French (6.2%). ...
... Regarding study interventions, 13 RCTs compared moxibustion with control [10,11,15,16,19,[21][22][23][24][25][27][28][29]; two RCTs compared acupuncture with control [17,22]; two RCTs compared moxibustion plus acupuncture with control [20,26]. Treatment was applied to BL67 in all included studies. ...
... Pooled data from two trials with 346 participants reveals significant difference between moxibustion plus acupuncture and control groups in the meta-analysis [20,26] (RR = 1.53; 95% CI = 1.26-1.86; random effect model, I2 = 0%). ...
Article
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Acupuncture-type interventions (such as moxibustion and acupuncture) at Bladder 67 (BL67, Zhiyin point) have been proposed to have positive effects on breech presentation. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of moxibustion and acupuncture in correcting breech presentation. We searched PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Electronic Periodical Services (CEPS), and databases at ClinicalTrials.gov to identify relevant randomized controlled trials (RCTs). In this study, sixteen RCTs involving 2555 participants were included. Compared to control, moxibustion significantly increased cephalic presentation at birth (RR = 1.39; 95% CI = 1.21–1.58). Moxibustion also seemed to elicit better clinical outcomes in the Asian population (RR = 1.42; 95% CI = 1.21–1.67) than in the non-Asian population (RR = 1.20; 95% CI = 1.01–1.43). The effects of acupuncture on correcting breech presentation after sensitivity analysis were inconsistent relative to control. The effect of moxibustion plus acupuncture was synergistic for correcting breech presentation (RR = 1.53; 95% CI = 1.26–1.86) in one RCT. Our findings suggest that moxibustion therapy has positive effects on correcting breech presentation, especially in the Asian population.
... Los primeros estudios que encontramos nos informan de que para aplicar la moxibustión debemos considerar la paridad y la edad gestacional y así poder validar la efectividad de la terapia 12 . También hay que tener en cuenta que la moxibustión si se aplica junto con la acupuntura, reduce la indicación de cesárea por presentación podálica, una indicación del 52.3% frente a un 66.7% si se deja evolucionar la situación de presentación podálica sin ninguna intervención, porque produce una versión cefálica del 53.6% frente al 36.7% que sigue su curso natural, y que es un método válido para mujeres que deseen un parto natural 13 . ...
... Otro hecho que se presentó en una mujer que se le había realizado la técnica de la moxibustión, aunque solo se ha descrito uno en la literatura científica, es el de macrotransfusión fetomaternal de 300 ml de sangre, que se diagnosticó tras la realización de TNE rutinario con ritmo silente e importantes deceleraciones 17 . Los resultados de otros estudios son muy variados, y aunque todos coinciden en el punto de aplicación, difieren en la metodología a seguir, en el tiempo que se debe aplicar la técnica y en las semanas de tratamiento, si bien todos coinciden que la edad gestacional para empezar es después de las 32 semanas de gestació [13][14][15]18,19 . ...
... No se ha registrado rotura prematura de membranas, ni un aumento de las tasas de cesárea; en cuanto al recién nacido, no se han encontrado alteraciones, ya que el apgar a los cinco minutos era mayor a 7 y no hubo muerte fetal intraparto 15 . Se han controlado la función cardiovascular en la madre y del feto y no se han producido alteraciones, ni contracciones prematuras 13 . La moxibustion puede ser beneficiosa para reducir la versión cefálica externa y la disminución de la cantidad de oxitocina antes y después del parto vía vaginal 8 . ...
Article
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Una de las posibles formas de transformar una presentación podálica en cefálica y así poder desarrollar un parto por vía vaginal es la versión cefálica externa (rotación manual del feto a través del abdomen de la madre). Para llevar a cabo esta técnica la presentación podálica debe mantenerse más allá de las 36 semanas, se debe de realizar a partir de las 37 semanas de gestación, y es una maniobra útil para reducir la tasa de presentación no cefálica8 . Se debe de realizar sin contracciones de parto, sin que la presentación de nalgas este introducida en la pelvis menor de la gestante, se debe realizar en un ambiente hospitalario y por personal preparado, antes debe de haberse realizado un test no estresante (TNE), una ecografía, un eventual test de Kleihauer y la perfusión de ritodine para frenar las contracciones, previa a la técnica. Esta técnica no está exenta de numerosas complicaciones: muerte fetal, hemorragia feto-maternal, etc. También hay una serie de factores favorables (multiparidad, placenta posterior, no obesidad de la mujer, presentación flotante, etc...), y contraindicaciones absolutas (crecimiento intrauterino retardado, parto en curso, gestosis, bolsa rota, etc...) y contraindicaciones relativas (oligoamnios índice de liquido amniótico (ILA) menor de 5, hidramnios ILA mayor de 25, circular, etc.)6 . Además hay estudios sobre otra posibilidad de versión externa a través de tratamiento postural (la madre descansa con la pelvis elevada) pero los resultados no respaldan su uso como algo eficaz9 .
... Pour diminuer le nombre de présentation du siège à l'accouchement et donc les comorbidités liées à ce type d'accouchement, de nombreux auteurs [6,11,12,15,19,24] proposent de réaliser des séances d'acupuncture, des versions par manoeuvre externe ou encore le pont de Bayer. Certaines équipes (35) préconisent l'utilisation d'une analgésie péridurale pour la réalisation du geste qui permettrait un taux de réussite de la manoeuvre de 58% contre 33% sans analgésie, mais cette technique à tendance à alourdir la VME. ...
... Bien que des études [6,24,36] On remarque que pour un tiers des patientes, une vérification de la présentation n'a pas été effectuée ou n'a pas été renseignée. Il est donc d'autant plus difficile de savoir si la réalisation des séances a été efficace ou non. ...
... Pour 93,3% des patientes, les séances ont été réalisées avant 36 semaines d'aménorrhée ce qui permet de ne pas freiner la tentative de version par manoeuvre externe, tout en permettant aux foetus de se verser avant celle-ci.Le nombre de séances réalisées est en majorité de trois. Ce nombre est en accord avec les différents auteurs[6,24].Néanmoins, on remarque que quatre patientes n'ont bénéficié que de deux séances. Pour une de ces quatre patientes, deux séances ont suffi à la version. ...
Thesis
PROBLÉMATIQUE: L'accouchement des foetus en présentation du siège est source de morbi-mortalité. Qu'en est- il de l'application du protocole concernant la prise en charge réalisée au troisième trimestre à la maternité régionale universitaire de Nancy ? MÉTHODE : Réalisation d'une étude exhaustive et rétrospective sur 99 patientes concernant l'application du protocole. RÉSULTATS : L'acupuncture ainsi que la version par manoeuvre externe ne sont que trop rarement proposées, respectivement 33,3% et 64%, bien qu'elles reçoivent une réponse favorable des patientes (80%, 97,8%). La réalisation des versions par manoeuvre externe est quant à elle conforme au protocole. La prise en charge réalisée au troisième trimes tre a permis de verser 6% des foetus en présentation du siège. Conclusion : La prise en charge des foetus en présentation du siège est positive pour la MRUN. Néanmoins, des améliorations sont à apporter concernant la proposition de l'acupuncture et de la version par manoeuvre externe.
... Nos ensaios clínicos (1,9,12,(18)(19)(22)(23)(24)(25) , foram excluídas as mulheres com gestações gemelares, risco de parto prematuro, comorbidades renais ou cardíacas, placenta prévia, historia de hemorragia pré-parto, restrição de crescimento intra-uterino, doença hipertensiva, isoimunização, cirurgia uterina prévia, anomalias uterinas, alterações fetais congênitas, contra-indicações para o parto vaginal e óbito fetal intra-útero. ...
... Os estudos foram conduzidos em diferentes países, como Dinamarca (1) , Austrália (12,17) e Nova Zelândia (17) , Espanha (13,18,21) , Holanda (5) , Suíça (9,19) , Reino Unido (2,7,20) , Itália (22)(23)(24) e China (25) , demonstrando que, apesar da técnica ser originalmente chinesa, já está bem popularizada nos países ocidentais. Percebe-se que muitos profissionais estão tão familiarizados com a moxabustão a ponto de sentir a necessidade de testar a sua eficácia para melhor segurança e confiança em aplicá-la na prática clínica. ...
... Sem evidências de que M tenha efeito (10) . A maioria dos estudos coletou dados sociodemográficos (1,9,12,(18)(19)(22)(23)(24)(25) , tipos de parto (1)(2)5,9,(12)(13)(18)(19)(20)(22)(23)(24)(25) , frequência de VCE (1,9,12,(18)(19)(22)(23)(24)(25) , efeitos adversos e sinais e sintomas (1,9,12,(18)(19)(20)(22)(23)(24) , relatados durante o tratamento. Alguns estudos se propuseram a identificar a opinião dos profissionais envolvidos quanto à técnica aplicada (5,17,20) . ...
Article
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O objetivo deste estudo foi conduzir uma revisão integrativa a fim de identificar publicações sobre a moxabustão e acupuntura para versão de fetos em apresentação pélvica. A ferramenta de pesquisa Paciente, Intervenção, Comparação e Desfecho, disponibilizada pela base de dados da Biblioteca Nacional de Medicina dos Estados Unidos, foi utilizada para gerar uma lista de artigos. As palavras utilizadas para a busca foram os termos breech, moxibustion, acupuncture e cephalic. A busca foi realizada no mês de março de 2016. Foram encontrados 24 registros, 18 foram analisados, dentre os quais sete foram favoráveis ao uso da moxabustão, e cinco, desfavoráveis. A partir dos estudos realizados sobre o tema, há evidências de que a moxabustão seja segura e efetiva para tentar “corrigir” apresentações pélvicas, apresentando-se como uma ferramenta no complemento da assistência prestada por profissionais na área da obstetrícia.
... 13,14 Moxibustion has been evaluated in two systematic reviews 15,16 and several randomized controlled trials. [17][18][19] and A study conducted in China showed a significant benefit from moxibustion performed daily (twice daily for some women) from 32 weeks of gestation. 17 However, its effectiveness and acceptability in a non-Chinese context is controversial, and, although one trial conducted in Europe has shown effectiveness, 18 another was unable to replicate these results. ...
... [17][18][19] and A study conducted in China showed a significant benefit from moxibustion performed daily (twice daily for some women) from 32 weeks of gestation. 17 However, its effectiveness and acceptability in a non-Chinese context is controversial, and, although one trial conducted in Europe has shown effectiveness, 18 another was unable to replicate these results. 19 The systematic reviews conclude that more research on the effectiveness of moxibustion is needed. ...
... A maximum of 14 sessions was scheduled over 2 weeks according to generally accepted protocols. 17,18 Before each hospital session, fetal presentation was verified using ultrasonography. The intervention was stopped when cephalic version was diagnosed or after 2 weeks of treatment. ...
Article
To estimate the efficacy of moxibustion between 34 and 38 weeks of gestation to facilitate the cephalic version of fetuses in breech presentation and the acceptability of this method by women. We conducted a randomized controlled trial in a Swiss university hospital maternity unit. We proposed to stimulate the acupoint BL 67 by moxibustion daily for 2 weeks for 212 consenting women between 34 and 36 weeks of gestation with a single fetus in breech presentation. We did the intervention three times weekly in the hospital and a teaching session and information leaflet on the technique for additional daily therapy at home. The control group received expectant management care. The availability of external cephalic version was maintained for both groups. The main outcome measure was the comparison of the proportion of women with cephalic presentation at delivery. Baseline characteristics were similar between groups, except more nulliparous women were randomized to moxibustion. The percentage of versions was similar between groups: 18% in the moxibustion group compared with 16% in the control group (relative risk 1.12, 95% confidence interval 0.62 to 2.03). Adjustment for the imbalance in parity did not change these results. The frequency of cesarean delivery was similar (64% compared with 58% in the moxibustion group and the control group, respectively). Acceptability of the intervention and women's perceptions of moxibustion were favorable. We observed no beneficial effect of moxibustion to facilitate the cephalic version of fetuses in breech presentation. Despite this lack of proven effectiveness, women had positive opinions on the intervention. ClinicalTrials.gov, www.clinicaltrials.gov,NCT00890474. I.
... We suspect the latter is more likely due to the observation that women felt increased foetal movements, uterine contractions and early spontaneous versions. Increased foetal move ments are common symptoms observed mainly in the moxibustion group as their comfort is scrutinised more [3,4,9,13,16] (Table 2). In Cardini's trial, 22% of women interrupted the trial due to noncompliance and premature exit [13]. ...
... Cardini experienced more initial re sistance to enter the trial out of concern for the foetus, whereas Danish women gladly accepted the trial when asked. The sideeffects of fumes by moxibustion are wellknown and were the prime reason for withdrawal in other studies [9,13]. Trial compliance improved if the partner was involved. ...
... The version percentage was unexpect [20]. According to two European studies, moxibustion has a significant effect [9,11]. Neri et al applied moxi bustion and acupuncture combined, but did not state the number of nulliparae. ...
Article
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Introduction: In Chinese traditional medicine, the stimulation of acupuncture point no. 67 - the bladder meridian - is recommended to favour cephalic version in case of foetal breech presentation. The point can be stimulated by an acupuncture needle, ginger application, fingertip pressure, laser or moxibustion; moxibustion is heat generated by a burning stick containing the herb Artemisia vulgaris. A Cochrane review concluded that more research on the effectiveness of moxibustion is needed. This study aimed to estimate the effectiveness of moxibustion for version of breech presentation. Methods: We included 200 women in gestational week 33 who had a singleton foetus in breech position. They were randomised to moxibustion treatment daily for two weeks or control without moxibustion. The randomisation was performed for nulliparous and parous women separately. Results: After the trial, which lasted on average 16 days, the breech position was confirmed in 68 of the 92 nulliparous and in 50 of the 108 parous women (74% versus 46%, p < 0.01); furthermore, cephalic position was verified in 76 women and other positions in six women. No significant difference regarding the incidence of breech position was found in the moxibustion group compared with the control group (risk ratio (RR) = 1.05, 95% confidence interval (CI): 0.8-1.38); nor in nulliparous (RR = 1.17, 95% CI: 0.77-1.76) or in parous women (RR = 1.0, 95% CI: 0.69-1.46); an RR > 1 favours moxibustion). Conclusions: No significant effects of moxibustion were found in correcting the breech position in primiparous and parous women after their 33rd gestational week. Funding: none. Trial registration: This trial was registered with ClinicalTrials.gov as NCT02251886.
... However, these studies were of moderate methodological quality, small and heterogenic. 8,11 Mexican midwives have used the rebozo technique during pregnancy and childbirth for centuries. Rebozo means shawl in Spanish and refers to the woven cloth that the midwife or another person uses to jiggle the pregnant or birthing women. ...
... In a Cochrane review, 15 only one intervention by one study indicated a positive effect of moxibustion (burning/combustion of a chemical compound, moxa) combined with acupuncture twice weekly from gestational age 33-35 weeks. 11 The comparability to the present intervention is low because the rebozo technique is a physical manipulation of the maternal pelvis before the ECV. A review of the effects of postural management of breech presentation found neither a positive nor a negative impact of adopting different postures. ...
Article
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Objective: To investigate if a hospital-initiated home-based rebozo intervention performed by the pregnant woman and her partner prior to external cephalic version (ECV) would increase the rate of cephalic presentations at birth. Design: A multicentre randomized controlled trial. Setting: Three university hospitals in Copenhagen, Denmark. Population: Pregnant women with a breech or transverse presentation at GA ≥35 weeks eligible for ECV. Methods: We compared rebozo prior to ECV with ECV alone. The randomization was computer-generated in blocks and stratified by parity. The woman and her partner were instructed in the technique by a project midwife and performed the technique at home 3 times daily for 3-5 days before the scheduled ECV. Analyses were by intention-to-treat. Main outcome measure: The number of cephalic presentations at the time of birth. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: 372 women were randomly assigned (1:1) to either rebozo intervention (n=187) or control (n=185). At birth, 95 (51%) in the intervention group vs. 112 (62%) in the control group had a fetus in cephalic presentation (OR 0.61; 95% CI 0.40-0.95). No adverse events were observed in relation to the intervention. Conclusions: In breech or transverse presentation, home-based rebozo exercise before ECV lowered the overall rate of cephalic presentation at birth..
... It may be beneficial to evaluate patient preference and level of distress/anxiety experienced due to the noncephalic presentation as a factor in the success of moxa. 20,21,29,30 LABOR Inducing labor is when the uterine contractions are stimulated during pregnancy before labor beginning spontaneously to achieve a vaginal birth. There are a number of health reasons that necessitate labor induction. ...
... They found that cardiotocograms were normal and there were no fetal side effects including, no fetal heart rate abnormalities, preterm uterine contractions, fetal distress, changes in short-term or long-term variability, or maternal cardiovascular changes. 21,29,30 There are no reports of the use of acupuncture for pregnant women who are unwell or in a high-risk category and more research is needed. ...
Article
Acupuncture is the procedure of inserting fine needles into specific points on the body for therapeutic purposes. Acupuncture and its derivatives (acupressure, moxibustion, electroacupuncture, and transcutaneous electric nerve stimulation on acupoints) are a popular treatment choice in the peripartum period (32 wk’ gestation to 14 d postdelivery). There is substantial research evidence supporting acupuncture and its derivatives in the peripartum period. Benefits in the use of acupressure to reduce labor pain intensity and a reduction in the duration of labor with acupressure have been found. There is mixed evidence for the use of both moxibustion and moxibustion with acupuncture for noncephalic presentations and for acupressure for reducing intraoperative nausea. There is limited evidence available on acupuncture use in women with high-risk pregnancies or multifetal gestations.
... e SRs highlight that in the Neri et al. [25] trial, which performed moxibustion plus acupuncture versus no treatment, there was a lower rate of cesarean sections in women (RR 0.79, 95% CI 0.64 to 0.98). In the Van den Berg et al. ...
... Articles excluded for irrelevant titles and abstract (n = 40) WoS (n = 60) Evidence-Based Complementary and Alternative Medicine et al. [25] that measures the heart rate and blood pressure of the pregnant woman and the fetal heart rate immediately after the intervention, with no changes detected. It also noted that preterm uterine contractions were not detected. ...
Article
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Background: 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.
... In this paper, we re-analysed, according to the Bayesian theory, the frequentist results expressed in terms of p-value for three studies of CAM and other fields [11][12][13][14]. ...
... A randomized controlled trial on moxibustion in obstetrics, i.e., stimulation with hot mugwort of a foot acupuncture point aimed to correct a breech presentation, found a significant (p-value 0.01) lower proportion of cephalic version in the control group in comparison to the treated women [11]. The p-value = 0.01 would result in a posterior probability of only 0.26, the prior odds assumed for such an implausible intervention being quite low (9:1). ...
Article
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It is not sufficiently known that frequentist statistics cannot provide direct information on the probability that the research hypothesis tested is correct. The error resulting from this misunderstanding is compounded when the hypotheses under scrutiny have precarious scientific bases, which, generally, those of complementary alternative medicine (CAM) are. In such cases, it is mandatory to use inferential statistics, considering the prior probability that the hypothesis tested is true, such as the Bayesian statistics. The authors show that, under such circumstances, no real statistical significance can be achieved in CAM clinical trials. In this respect, CAM trials involving human material are also hardly defensible from an ethical viewpoint.
... Cognitive impairment is an age-dependent chronic disorder 1 ; Q5 globally, the number of patients is expected to reach 82 million in 2030 and 152 million in 2050. 2 Alzheimer disease (AD) is the most common type of cognitive impairment, 3 accounting for 60-80% of all cases, 2,4 which is characterized by the accumulation of A␤ pep-such as ginger between the moxa cones and the skin) to transmit heat stimulation 8,9 and induce pharmacological action via herbal components. 10,11 In addition to its wide range of use for pain relief 12,13 and inflammation control, 14,15 moxibustion has been recognized as a suitable treatment for cognitive impairment, with several recent studies indicating its efficacy in patients with dementia. 16,17 Acupuncture, another representative traditional Chinese medicine treatment, has been reported to be effective in cognitive enhancement, with supporting evidence from several systematic reviews (SRs), 18,19,20 suggesting that its potential mechanism involves suppression of oxidative stress and neuroinflammation and modulation of glucose metabolism 5 and neuronal signaling pathways. ...
Article
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Background Cognitive impairment is an age-dependent chronic disorder that exponentially worsens with age; however, it treatment is mostly symptomatic. Moxibustion is widely accepted in East Asia as a treatment for cognitive impairment. This systematic review aimed to verify the efficacy and underlying mechanism of moxibustion in treating cognitive impairment. Methods Sixteen trials involving 324 animals obtained from MEDLINE (PubMed), EMBASE, the Cochrane library, the Chinese National Knowledge Infrastructure, Wan-Fang, Cqvip, the Korean Studies Information Service System, and the Oriental Medicine Advanced Searching Integrated System met the inclusion criteria. We extracted the results of behavioral tests and immunohistochemical biomarkers from the included articles and evaluated the risk of bias and reporting quality. Results The moxibustion group showed significantly decreased escape latency, increased crossing times, and prolonged dwelling times in the Morris water maze test. There was a significantly enhanced latency period and reduced error time in the step-down test and nerve behavior score. The effects of moxibustion were found to be mediated by suppression of oxidative stress and apoptosis, modulation of inflammation and Aβ genesis activation of vascular endothelial growth factor, and adjustment of metabolites in the tricarboxylic acid cycle and fatty acid metabolism. Conclusion Our results demonstrated the therapeutic efficacy of moxibustion on cognitive impairment and suggested the putative mechanism. However, considering the small number of included studies, high bias risk, low reporting quality, and the limitations of animal experimentation, our results need to be confirmed by more detailed studies.
... Several interventions, including application of tocolytic agents, anesthetic managements, and more adjuvant interventions, [6][7][8] have been investigated extensively aiming at increasing rate of successful ECV and improving overall perinatal outcomes. While tocolysis has been proven to be effective for facilitating ECV, the involvement of anesthesia care in ECV is not without controversy. ...
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Background: External cephalic version (ECV) is a frequently performed obstetric procedure for fetal breech presentation to avoid cesarean delivery. Neuraxial, intravenous, and inhalational anesthetic techniques have been studied to reduce maternal discomfort caused by the forceful manipulation. This study compares the effects of these anesthetic techniques on ECV and incidence of cesarean delivery. Methods: We conducted a comprehensive literature search for published randomized controlled trials (RCTs) or well-conducted quasi-randomized trials of ECV performed either without anesthesia or under neuraxial, intravenous, or inhalational anesthesia. Pairwise random-effects meta-analyses and network meta-analyses were performed to compare and rank the perinatal outcomes of the 3 anesthetic interventions and no anesthesia control, including the rate of successful version, cesarean delivery, maternal hypotension, nonreassuring fetal response, and adequacy of maternal pain control/satisfaction. Results: Eighteen RCTs and 1 quasi-randomized trial involving a total of 2296 term parturients with a noncephalic presenting singleton fetus were included. ECV under neuraxial anesthesia had significantly higher odds of successful fetal version compared to control (odds ratio [OR] = 2.59; 95% confidence interval [CI], 1.88-3.57), compared to intravenous anesthesia (OR = 2.08; 95% CI, 1.36-3.16), and compared to inhalational anesthesia (OR = 2.30; 95% CI, 1.33-4.00). No association was found between anesthesia interventions and rate of cesarean delivery. Neuraxial anesthesia was associated with higher odds of maternal hypotension (OR = 9.33; 95% CI, 3.14-27.68). Intravenous anesthesia was associated with significantly lower odds of nonreassuring fetal response compared to control (OR = 0.36; 95% CI, 0.16-0.82). Patients received neuraxial anesthesia reported significantly lower visual analog scale (VAS) of procedure-related pain (standardized mean difference [SMD] = -1.61; 95% CI, -1.92 to -1.31). The VAS scores of pain were also significantly lower with intravenous (SMD = -1.61; 95% CI, -1.92 to -1.31) and inhalational (SMD = -1.19; 95% CI, --1.58 to -0.8) anesthesia. The VAS of patient satisfaction was significantly higher with intravenous anesthesia (SMD = 1.53; 95% CI, 0.64-2.43). Conclusions: Compared to control, ECV with neuraxial anesthesia had a significantly higher successful rate; however, the odds of maternal hypotension increased significantly. All anesthesia interventions provided significant reduction of procedure-related pain. Intravenous anesthesia had significantly higher score in patient satisfaction and lower odds of nonreassuring fetal response. No evidence indicated that anesthesia interventions were associated with significant decrease in the incidence of cesarean delivery compared to control.
... D'où l'intérêt de la version par moxibustion initiée par les chinois dès 1983 [29]. De nombreux ECR sont parus à sa suite avec des résultats contradictoires [31][32][33][34][35][36][37][38][39][40] ...
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Introduction. L'objectif de ce travail est d'évaluer la possibilité d'utiliser la moxibustion en obstétrique. Méthodes. Après avoir étudié l'origine, les différentes variétés, puis décrit les caractéristiques générales de la moxibustion, à savoir les effets thermiques, électro-magnétiques et pharmacologiques, cette étude synthétique s'intéressera aux effets secondaires et la sécurité. Des études de cas concernant l'intérêt de la moxibustion dans les versions pour présentation de siège seront à la base de la discussion faisant un état des lieux des méta-analyses et des essais comparatifs randomisés (ECR) ainsi que d'une explication théorique des mécanismes d'action de la moxibustion. Même approche concernant le syndrome douloureux pelvien gravidique (syndrome de Lacomme) et les douleurs lombaires basses. Les autres applications de la moxibustion, telles l'asthénie, l'accélération du travail seront également étudiées. Résultats. Il est souhaitable que la moxibustion soit proposée dans le panel des soins de santé à offrir aux femmes enceintes associée ou non aux autres techniques comme l'acupuncture ou l'électroacupuncture.. Conclusion. La moxibustion peut être utilisée seule ou en association avec le traitement classique dans le cadre de la médecine intégrative. Selon les preuves issues des méta-analyses, des ECR, on peut considérer sa contribution utile, efficace et sans effets indésirables. Néanmoins, du fait de nombreux biais (population insuffisante, grande hétérogénéité des ECR, etc.), il est nécessaire de réaliser des ECR de grande qualité méthodologique pour que l'on puisse proposer la moxibustion en obstétrique avec un grade A de preuve scientifique établie selon la Haute Autorité de Santé française. Mots clés : Moxibustion-présentation du siège-obstétrique-syndrome de Lacomme-syndrome douloureux pelvien-mécanismes d'action. Summary: Introduction. The objective of this work is to evaluate the possibility of using moxibustion in obstetrics. Methods. After studying the origin, the different varieties and then describing the general characteristics of the moxibustion, namely the thermal, electromagnetic and pharmacological effects, this synthetic study will focus on side effects and safety. Case studies of the relevance of moxibustion in breech versions will form the basis of the discussion of the state of play of meta-analyzes and randomized controlled trials (RCTs) as well as a theoretical explanation of mechanisms of action of moxibustion. Same approach regarding pelvic pain syndrome (Lacomme syndrome) and low back pain. Other applications of moxibustion, such as asthenia, acceleration of work will also be studied. Results. It is desirable that moxibustion be offered in the panel of health care to offer to pregnant women associated or not with other techniques such as acupuncture or electroacupuncture. Conclusion. Moxibustion can be used alone or in combination with conventional therapy in integrative medicine. According to the evidence from the meta-analyzes, RCTs, one can consider its contribution useful, effective and without undesirable effects. However, because of many biases (insufficient population, high heterogeneity of RCTs, etc.), it is necessary to perform RCTs of high methodological quality so that moxibustion in obstetrics can be proposed with a grade A of established scientific evidence established by the French High Authority of Health.. Keywords: Moxibustion-presentation of the seat-obstetrics-Lacomme syndrome-pelvic pain syndrome-mechanisms of action.
... Other research demonstrated their use of forbidden points for augmenting labor, 19 and the points have been reported to stimulate uterine contractions and study withdrawal when used for cephalic versions of breech-presenting babies. 44 While forbidden points were selected in these medical acupuncture research protocols, within a TCM framework, these points are not considered to be essential for clinical practice and women have reported clinically meaningful reduction of their lower-back pain/pelvic pain without the use of these points. 11 Within a TCM framework, the use of these points is performed with knowledge and philosophical understanding to guide the treatment. ...
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Objective: Pregnancy is a complex physical and hormonal condition. Many women experience back and pelvic pain, reflux, and headaches during pregnancy. There has been a significant rise in the popularity of acupuncture for pain conditions in pregnancy, wherein nonpharmacologic options are important. Concerns have been raised by both traditional and medical acupuncturists about using "forbidden points" during pregnancy and the risk of preterm contractions (PTC), as this could limit women's and practitioners' willingness to continue treatment during pregnancy. There is also a risk of bias introduced into clinical trials when participants are highly selected or they drop out of studies due to adverse outcomes. This review examined randomized controlled trials (RCTs) of acupuncture using forbidden points prior to 37 weeks of pregnancy to treat pain conditions, with the primary outcome of PTC. Methods: A database search identified RCTs, including trials of penetrating acupuncture that used forbidden points in their protocols to treat pregnancy-related pain conditions. STRICTA [Standards for Reporting Interventions in Clinical Trials of Acupuncture] and GRADE [Grades of Recommendation, Assessment, Development, and Evaluation] criteria were used to assess the quality of evidence. This review includes 8 RCTs reporting on 713 women. Results: Only 2 studies reported on the primary outcome of PTC, and there were insufficient data to perform a primary analysis. In these 2 studies, 6 participants withdrew due to PTC. No study was at a low risk of bias for all GRADE domains, and 3 studies were at high or unclear risk of bias in all domains. Conclusions: PTC is an important clinical outcome and should be reported routinely. The strength of evidence to date is insufficient to recommend using forbidden points prior to 37 weeks of pregnancy. Highly selected patient populations, risk of bias in study design, and participant withdrawal rates, suggest that high-quality trials are required.
... Our double-step strategy has further increased the foetal upheavals, limiting the need of the doctor. Another similar study with the use of acupuncture and moxibustion achieved global success of 53.6% [15], but the need for the presence of the doctor (in Italy acupuncture must be administered by a doctor) commits more resources. In our study the doctor intervened only in case of failure of the self-administered Evidence-Based Complementary and Alternative Medicine 5 moxibustion. ...
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Introduction: Foetal breech presentation is an obstetric problem that often leads to caesarean section. Stimulation of the acupoint BL67 by moxibustion may correct breech presentation. Methods: We observed 93 pregnant women in the 32nd-35th week of gestation with normal pregnancy and ultrasound diagnosis of breech presentation. The patients received stimulation of acupoint BL67 by self-administered moxibustion once a day for two weeks and if foetuses still were in breech presentation, moxibustion, and needle in the points BL65 and SI1, lasting 30 minutes, for three days in one week. The main outcome was vaginal birth with vertex presentation at delivery; the secondary outcome was compliance in the self-administration of the moxibustion treatment. Results: We observed cephalic version and natural childbirth in 62.4% of all treated women. The treatment was accepted by 98.9% women (93/94), and compliance was 91.4% (85/93) for self-administered moxibustion and 37.5% (12/32) for moxibustion and needle treatment. Conclusions: On the basis of our results, self-administered home treatment moxibustion followed by moxibustion and needle stimulations may be an effective and low-cost treatment for inducing cephalic version.
... Several interventions, including application of tocolytic agents, anesthetic managements, and more adjuvant interventions, [6][7][8] have been investigated extensively aiming at increasing rate of successful ECV and improving overall perinatal outcomes. While tocolysis has been proven to be effective for facilitating ECV, the involvement of anesthesia care in ECV is not without controversy. ...
... 48,49 Existen técnicas y esquemas de puntos que se utilizan para ayudar a la concepción 50 y tratar alteraciones del ciclo menstrual, molestias del embarazo, 51,52 pirosis, dolor de espalda y pélvico, 53,54 insomnio, 55 dolor abdominal, fortalecimiento del sistema inmunológico, anomalías de la posición fetal. 56,57 Durante el parto, como apoyo en su inducción, 58 manejo de la ansiedad, dolor de espalda, regulación del trabajo de parto y reducción del dolor, 32, 59,xxiv retención de la placenta. Después del parto, para favorecer la tonicidad de la recién parida, tratar el dolor posparto, los problemas con la lactancia y la depresión postnatal. ...
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Boletín género y salud en cifras., 2012 Después de cuatro años de participar en el Comité regularmente, he visto reforzada la tarea editorial de manera importante en Género y Salud en Cifras] de ser una publicación con un formato, digo yo "muy médico", a otra que da cabida a contribuciones de carácter cualitativo que presentan análisis desde diferentes disciplinas sociales aplicadas a la temática de salud pública. Las representaciones sociales y las prácticas de la salud son aspectos medulares a tomar en consideración para implementar las políticas públicas en el campo de la salud en todas y cada una de las áreas, no solo en la sexual y reproductiva. Las investigaciones de corte cualitativo y mixto están permitiendo conocer y entender las trayectorias de todo tipo de padecimientos, así como sus diferentes manifestaciones entre mujeres y hombres. Recuperar las explicaciones que ellas y ellos dan a los padecimientos tiene valor indiscutible para el trabajo de organización y planeación de las acciones de todo tipo en el campo de la salud. Por lo tanto, la revista, que ahora cumple su primera década, resulta se un medio muy valioso de tenerse en cuenta para innovar la mirada, la política y las acciones de salud en favor de mujeres y hombres.
... Moxibustion is the burning of dried herbs, such as mugwort, at one or more relevant acupoints, thereby imparting both heat stimulation via infrared radiation [4,6] and the pharmacological action of the herbal components to the site of application [7,8]. Moxibustion has recently become popular in gynecology for managing fetal breech presentation and the pain of primary dysmenorrhea [9,10]. Moreover, moxibustion has been reported to prevent inflammation, organ dysfunction [11,12], and hormonal imbalances [13]. ...
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Cognitive impairment is age-related and manageable only with early diagnosis and prevention. Moxibustion is widely accepted in East Asia as useful for preventing cognitive impairment. This systematic review of animal studies was conducted to verify the efficacy of moxibustion in preventing cognitive impairment and to elucidate the underlying mechanism. Randomized controlled animal trials that established the efficacy of moxibustion in preventing cognitive impairment were included in the analysis. Results of behavioral tests and the signaling pathways elucidated were extracted and a meta-analysis was conducted with the behavioral test results. The risk of bias was evaluated using 9 items, and reporting quality was evaluated using the ARRIVE (Animal Research: Reporting In Vivo Experiments) Guidelines Checklist. Ten trials involving 410 animals met the inclusion criteria. All studies reported the benefit of moxibustion in preventing cognitive deficits caused by Alzheimer's disease (AD). Among five studies using the Morris water maze test, a significant effect of moxibustion in decreasing the escape time was reported in three studies, increasing the crossing times in four studies, and prolonging the dwelling time in two studies. The effects of moxibustion were demonstrated to be mediated by an increase in the activity of neurotrophins and heat shock protein, modulation of the cell cycle, and suppression of apoptosis and inflammation. However, considering the small number of included studies, the lack of studies investigating entire signaling pathways, and a high risk of bias and low reporting quality, our results need to be confirmed through more detailed studies.
... En la literatura científica encontramos varios estudios desarrollados con una metodología similar a la utilizada en el presente estudio 3,13,16,18,19,23,24 . En la mayoría de estos trabajos el GC no recibía ningún tipo de tratamiento, a excepción de dos estudios, en uno de los cuales se aplicaba un láser en el punto BL67-ziying 24 y en el otro la técnica de moxibustión en el punto SP1-yinbai, igual que en el presente ensayo 19 . ...
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ABSTRACT Aim: To evaluate moxibustion efficacy, combined with knee-chest position, for foetus version from no cephalic presentation to cephalic presentation during the 3rd trimester of gestation. To evaluate the security of the moxibustion technique and to identify type of delivery, weeks of gestation and the weight of the newborn. Subjects, material and methods: Multicenter, randomized, controlled trial conducted in 9 primary care centres focused on sexual and reproductive health of the Baix Llobregat (Barcelona) region. Selection was done after the 3rd trimester ultrasound scan. When a non-cephalic presentation was found, women were asked to join the study. After signing the informed consent, random allocation took place and they were divided into intervention group (IG) and control group (CG). IG received a one week treatment with moxibustion at point BL67 combined with knee-chest position. CG received moxibustion treatment at a neutral point combined with knee-chest position too. For both groups they were given the necessary explanations for a correct application twice a day during a week. Results: A total 88 pregnant women between 32-36 weeks of gestation were studied, 47 pregnant mothers enrolled in IG and 41 in CG, with similar characteristics at the beginning of the study. Number of performed sessions was similar for both groups and without complications.
... Usually, NST is used as a screening test, and if the result is abnormal (nonreactive), the additional tests such as contraction stress test or biophysical profile will be done. [6] Given that NST is a simple, less expensive, noninvasive, and does not need uterine contractions, [7] and it is often used as the first technique to assess fetal health and survival, [8] and due to the fact that the mother's reference for other tests and treatment interventions is based on the results of stress tests, therefore, developing methods that are likely to increase the diagnostic power of negative (normal) results of test and have chance of shortening the time seems appropriate and necessary. [9] To reduce false-positive results of this test, various methods have been suggested such as moving baby, prolonging the time of testing, audio stimulation of the fetus before test and positioning mother during testing, using complementary medicine, and acupressure points. ...
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CONTEXT One of the main goals of antenatal testing is to identify fetuses at the risk of neurologic injury or death so that these adverse outcomes can be prevented. We want to assess the effects of BL67 points’ stimulation on fetal heart rate parameters and fetal movements during nonstress test (NST). We did a quasi-experimental design in Shahid Beheshti Hospital in Isfahan in 2011. AIMS This study aims to assessment of the effects of BL67 points’ stimulation on fetal heart rate parameters and fetal movements. SETTINGS AND DESIGN We did a randomized controlled clinical trial in Shahid Beheshti Hospital in Isfahan in 2011. SUBJECTS AND METHODS This study is a quasi-experimental design that was conducted in one group and the two steps (before-after study). Participants were pregnant women (primigravida) who were 35–18 years that refer to Shahid Beheshti Hospital in Isfahan in 2011 to receive routine prenatal care. The 32 pregnant women were selected for acupressure during the second NST. STATISTICAL ANALYSIS USED The statistical processing was performed by descriptive, paired t-test through SPSS version 20. RESULTS There was no significant difference in mean number of accelerations in fetal heart rate and mean number of fetal movement before and after intervention; however, there was a significant difference in mean time to the second acceleration before and after the intervention (P = 0.04). CONCLUSIONS No difference between parameters of the fetal heart rate before and after stimulation and lack of uterine response by this method is a significant advantage and is probably why stimulating this point could not create a risk to the fetuses.
... No existe consenso sobre la eficacia y seguridad de esta terapia, y tampoco sobre el momento de la gestación en que debe aplicarse, durante cuánto tiempo y con qué frecuencia 1, [3][4][5]12,13,[16][17][18]20,24 . ...
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Introduction: The incidence of fetal breech presentation in Spain is of 3.8%. Moxibustion is an integral part of the ancient traditional Chinese medicine. The technique involves placing an incandescent stick of Artemisia vulgaris a few inches of the acupuncture point Zhiyin (point 67 of the bladder meridian, located at the outer base of the nail of the fifth toe). The objectives are: 1. To find out what percentage of fetuses have turned around to a cephalic presentation due to moxibustion in pregnant women displaying fetal malposition after the 32nd week of pregnancy; 2.To identify any materno-fetal complications associated with the use of the technique. Subjects: A total of eighteen pregnant women were studied with more than 32 weeks of gestation. Material and methods: Through a descriptive study with one group intervention, we analyzed the percentage of cephalic fetus that rotated with this therapy. Results: Fifteen pregnant women (83.9%) did the treatment properly; three pregnant women (16.7%) carried out the treatment on an occasional basis and ended with a caesarean section due to buttocks. Conclusions: It seems reasonable to say that compliance with the treatment influences the type of delivery (χ 2= 12.600; gl= 1; p= 0.000), but does not modify the Apgar of the newborn. This technique is presented as an economic, safe, simple and practical alternative, for the fetal version of breech presentation.
... Stimulation of BL67 is also helpful for accelerating cervical dilation to achieve pain relief and analgesia during labor; this treatment is effective in about 75% of the patients [27,28]. Bilateral acupuncture plus moxibustion at BL67 was more effective than observation in correcting fetal breech presentation at 33-35 weeks of gestation in Italian women [29]. Therefore, the application of BL67 for correcting fetal malpresentation may be a relatively simple, efficacious, and inexpensive method associated with a lower percentage of operatively completed deliveries [25]. ...
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Objective: To investigate the efficacy of stimulation at the Jing-Well points of meridians in advanced clinical practice. Methods: Articles including English or Chinese keywords on the Jing-Well points of meridians published between 2001 and August 2012 were sourced from the Cochrane Library, PubMed, and China National Knowledge Infrastructure databases. On the basis of these reports, we explored the modern applications, mechanisms, and efficacy of the Jing-Well points. Results: Thirty-five related studies, published mainly in Chinese, were identified. Evidence was found to support the use of Jing-Well point stimulation in the treatment of stroke, persistent vegetative status, severe head injury, vascular dementia, Alzheimer's disease, upper respiratory infection, bronchial asthma, hysterical aphonia, postpartum lactation insufficiency, fetal malpresentation, dysmenorrhea, acne, sudden deafness, sleeping disorders, and post-chemotherapy nausea and vomiting. Conclusion: Diseases associated with the 12 meridians and meridional dermomeres (十二皮部) can be treated by stimulating the related Jing-Well points. Stimulation of all the Jing-Well points can activate and restore function in the damaged brain. Rigorous high-quality trials are needed to improve the level of evidence on their effectiveness and safety.
... Moxibustion (see Ch. 50) may be beneficial in reducing the need for ECV. However, there is a need for well-designed randomized controlled trials to evaluate moxibustion for breech presentation which should report on clinically relevant outcomes as well as the safety of the intervention (Cardini et al 2005, Neri et al 2004. ...
Article
573 31 Malpositions and malpresentations of the fetus present the midwife with a challenge of recognition and diagnosis both in the antenatal period and during labour. This chapter aims to: • outline the causes of these positions and presentations • discuss the midwife's diagnosis and management • describe the possible outcomes. Occipitoposterior positions Occipitoposterior positions are the most common type of malposition of the occiput and occur in approxi-mately 10% of labours. A persistent occipitoposterior position results from a failure of internal rotation prior to birth. This occurs in 5% of births (Pearl et al 1993). The vertex is presenting, but the occiput lies in the posterior rather than the anterior part of the pelvis. As a consequence, the fetal head is deflexed and larger diameters of the fetal skull present (Fig. 31.1).
... La primera se refiere a cuál es la edad gestacional óptima en la que debe iniciarse el tratamiento. Algunos autores sugieren que entre la 32 y la 37 semanas 12,21-23 , mientras que otros abogan por no aplicarla hasta después de la semana 35, debido al riesgo teórico de inducir contracciones provocando un parto prematuro 24 . No hay ninguna base empírica para esta afirmación. ...
Article
Objective To compare the effectiveness of additional moxibustion at point BL 67 with moxibustion at a non-specific acupuncture point and with usual care alone to correct non-vertex presentation. Methods This was a multicentre randomised controlled trial in which 406 low-risk pregnant women with a fetus in ultrasound breech presentation, with a gestational age of 33-35 weeks, were assigned to: a) true moxibustión at point BL 67 plus usual care; b) moxibustion at SP 1, a non-specific acupuncture point (sham moxibustion) plus usual care; or c) usual care alone. The primary outcome was cephalic presentation at birth. Women were recruited at health centres in primary healthcare. Results In the true moxibustion group, 58.1% of the full-term presentations were cephalic compared with 43.4% in the sham moxibustion group (relative risk [RR]: 1.34; 95% confidence interval [95%CI], 1.05-1.70) and 44.8% of those in the usual care group (RR: 1.29; 95%CI, 1.02-1.64). The reduction in RR of the primary outcome in women allocated to the true moxibustion group compared with the usual care group was 29.7% (95%CI, 3.1-55.2) and the number needed to treat was 8 (95%CI, 4-72). There were no severe adverse effects during the treatment. Conclusions Moxibustion at acupuncture point BL 67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. We believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus.
Article
Background: Breech presentation at term can cause complications during birth and increase the chance of caesarean section. Moxibustion (a type of Chinese medicine which involves burning a herb close to the skin) at the acupuncture point Bladder 67 (BL67) (Chinese name Zhiyin), located at the tip of the fifth toe, has been proposed as a way of changing breech presentation to cephalic presentation. This is an update of a review first published in 2005 and last published in 2012. Objectives: To examine the effectiveness and safety of moxibustion on changing the presentation of an unborn baby in the breech position, the need for external cephalic version (ECV), mode of birth, and perinatal morbidity and mortality. Search methods: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, and conference proceedings), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (4 November 2021). We also searched MEDLINE, CINAHL, AMED, Embase and MIDIRS (inception to 3 November 2021), and the reference lists of retrieved studies. Selection criteria: The inclusion criteria were published and unpublished randomised or quasi-randomised controlled trials comparing moxibustion either alone or in combination with other techniques (e.g. acupuncture or postural techniques) with a control group (no moxibustion) or other methods (e.g. acupuncture, postural techniques) in women with a singleton breech presentation. Data collection and analysis: Two review authors independently determined trial eligibility, assessed trial quality, and extracted data. Outcome measures were baby's presentation at birth, need for ECV, mode of birth, perinatal morbidity and mortality, maternal complications and maternal satisfaction, and adverse events. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: This updated review includes 13 studies (2181 women), of which six trials are new. Most studies used adequate methods for random sequence generation and allocation concealment. Blinding of participants and personnel is challenging with a manual therapy intervention; however, the use of objective outcomes meant that the lack of blinding was unlikely to affect the results. Most studies reported little or no loss to follow-up, and few trial protocols were available. One study that was terminated early was judged as high risk for other sources of bias. Meta-analysis showed that compared to usual care alone, the combination of moxibustion plus usual care probably reduces the chance of non-cephalic presentation at birth (7 trials, 1152 women; risk ratio (RR) 0.87, 95% confidence interval (CI) 0.78 to 0.99, I2 = 38%; moderate-certainty evidence), but the evidence is very uncertain about the effect of moxibustion plus usual care on the need for ECV (4 trials, 692 women; RR 0.62, 95% CI 0.32 to 1.21, I2 = 78%; low-certainty evidence) because the CIs included both appreciable benefit and moderate harm. Adding moxibustion to usual care probably has little to no effect on the chance of caesarean section (6 trials, 1030 women; RR 0.94, 95% CI 0.83 to 1.05, I2 = 0%; moderate-certainty evidence). The evidence is very uncertain about the effect of moxibustion plus usual care on the the chance of premature rupture of membranes (3 trials, 402 women; RR 1.31, 95% CI 0.17 to 10.21, I2 = 59%; low-certainty evidence) because there were very few data. Moxibustion plus usual care probably reduces the use of oxytocin (1 trial, 260 women; RR 0.28, 95% CI 0.13 to 0.60; moderate-certainty evidence). The evidence is very uncertain about the chance of cord blood pH less than 7.1 (1 trial, 212 women; RR 3.00, 95% CI 0.32 to 28.38; low-certainty evidence) because there were very few data. We are very uncertain whether the combination of moxibustion plus usual care increases the chance of adverse events (including nausea, unpleasant odour, abdominal pain and uterine contractions; intervention: 27/65, control: 0/57), as only one study presented data in a way that could be reanalysed (122 women; RR 48.33, 95% CI 3.01 to 774.86; very low-certainty evidence). When moxibustion plus usual care was compared with sham moxibustion plus usual care, we found that moxibustion probably reduces the chance of non-cephalic presentation at birth (1 trial, 272 women; RR 0.74, 95% CI 0.58 to 0.95; moderate-certainty evidence) and probably results in little to no effect on the rate of caesarean section (1 trial, 272 women; RR 0.84, 95% CI 0.68 to 1.04; moderate-certainty evidence). No study that compared moxibustion plus usual care with sham moxibustion plus usual care reported on the clinically important outcomes of need for ECV, premature rupture of membranes, use of oxytocin, and cord blood pH less than 7.1, and one trial that reported adverse events reported data for the whole sample. When moxibustion was combined with acupuncture and usual care, there was very little evidence about the effect of the combination on non-cephalic presentation at birth (1 trial, 226 women; RR 0.73, 95% CI 0.57 to 0.94) and at the end of treatment (2 trials, 254 women; RR 0.73, 95% CI 0.57 to 0.93), and on the need for ECV (1 trial, 14 women; RR 0.45, 95% CI 0.07 to 3.01). There was very little evidence about whether moxibustion plus acupuncture plus usual care reduced the chance of caesarean section (2 trials, 240 women; RR 0.80, 95% CI 0.65 to 0.99) or pre-eclampsia (1 trial, 14 women; RR 5.00, 95% CI 0.24 to 104.15). The certainty of the evidence for this comparison was not assessed. Authors' conclusions: We found moderate-certainty evidence that moxibustion plus usual care probably reduces the chance of non-cephalic presentation at birth, but uncertain evidence about the need for ECV. Moderate-certainty evidence from one study shows that moxibustion plus usual care probably reduces the use of oxytocin before or during labour. However, moxibustion plus usual care probably results in little to no difference in the rate of caesarean section, and we are uncertain about its effects on the chance of premature rupture of membranes and cord blood pH less than 7.1. Adverse events were inadequately reported in most trials.
Article
Abstrak : Sectio Caesarea merupakan jenis persalinan buatan melalui proses insisi pada dinding perut dan dinding Rahim. Persalinan Sectio Caesarea dianjurkan dilakukan ketika ditemui adanya indikasi medis yang menyebabkan hambatan dalam proses persalinan. Berdasarkan data RISKESDAS tahun 2012 tercatat tingkat pesalinan sectio caesarea di Indonesia sudah melewati batas maksimal standar WHO yaitu 5% - 15%. Penelitian ini bertujuan utama untuk mengetahui gambaran atau deskripsi tentang indikasi persalinan Sectio Caesarea di RSUD Kota Kendari. Jumlah sampel pada penelitian ini sebanyak 360 responden yang melakukan persalinan Sectio Caesarea di RSUD Kota Kendari tahun 2018. Pengumpulan data menggunakan data sekunder dengan melihat medical record. Hasil penelitian didapatkan bahwa indikasi persalinan Sectio Caesarea berdasarkan distosia persalinan paling banyak disebabkan oleh janin (Passenger) sebanyak 140 (39%) indikasi, faktor lain yaitu 120 (33,3%) indikasi, kekuatan (Power) 66 (18,3%) indikasi, dan jalan lahir (Passage) sebanyak 34 (9,4%) indikasi. Saran bagi petugas kesehatan agar lebih meningkatkan pendidikan kesehatan terkait dengan persalinan sectio caesarea dan komplikasi post sectio caesarea, Absctract : Sectio Caesarea is a type of artificial birth through an incision process in the abdominal wall and uterine wall. Sectio Caesarea delivery is recommended when there are medical indications that cause obstacles in the delivery process. Based on RISKESDAS data in 2012, it was recorded that the section caesarean delivery rate in Indonesia had exceeded the WHO standard maximum limit of 5% - 15%. This study aims primarily to find out the description or description of the indications for Sectio Caesarea delivery at the Kendari City Hospital. The number of samples in this study were 360 respondents who gave birth to Sectio Caesarea at Kendari City Hospital in 2018. Data collection used secondary data by looking at medical records. The results showed that the indication for Sectio Caesarea delivery based on labor dystocia was mostly caused by the fetus (Passenger) with 140 (39%) indications, other factors namely with 120 (33.3%) indications, power with 66 (18.3%) indications, and the birth canal (Passage) with 34 (9.4%) indications. Suggestions for health workers to further improve health education related to labor sectio caesarea and post sectio caesarea complications.
Article
Viele Schwangere leiden unter Beschwerden, die mit Akupunktur gut behandelt werden können. Dieser Artikel fasst die wichtigsten Beschwerdebilder mit entsprechenden Behandlungsvorschlägen zusammen.
Article
Importance Acupuncture is a key component of therapy in traditional Chinese medicine. Only in the last few decades has acupuncture become popular in the United States. The mechanism behind acupuncture's effects on the body and brain has not been completely elucidated, but there is evidence that acupuncture has effects on the endocrine, immune, and sympathetic and parasympathetic nervous systems. It may also act through electrical and mechanical signaling through the connective tissue and fascia. Despite this uncertainty, the positive effects of acupuncture have been well established. Objective In this review, we discuss the basic concepts of traditional Chinese medicine and acupuncture and examine the evidence regarding the use of acupuncture in obstetrics and gynecology. Evidence Acquisition We conducted a literature review of acupuncture in obstetrics and gynecology using PubMed. Results The available data demonstrate that acupuncture is beneficial in the treatment of labor pain, back pain in pregnancy, and dysmenorrhea. It is unclear if acupuncture is effective for hyperemesis, chemotherapy-induced nausea and vomiting, and menopausal hot flushes, or if moxibustion is effective in correcting breech presentation. There are limited but positive data regarding menopause-related sleep disturbances, depression in pregnancy, and overactive bladder. Acupuncture is not beneficial for improving outcomes in in vitro fertilization. Conclusions and Relevance Acupuncture is an increasingly popular therapy with many potential applications in obstetrics and gynecology. A general understanding of the basic principles of acupuncture and the safety and efficacy of its practice is necessary for the general obstetrician and gynecologist to make informed recommendations to patients. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to identify the basic concepts of traditional Chinese medicine and how it differs from Western medicine; describe common obstetrical and gynecologic issues that can be successfully treated with acupuncture; and distinguish the main issues in designing acupuncture studies regarding blinding, choosing a control group, and identifying areas of potential bias.
Article
Moxibustion, a form of traditional Chinese medicine (TCM), is the burning of the herb moxa (Folium Artemisiae argyi or mugwort) over acupuncture points. It is often used in China to facilitate cephalic version of breech presentation. This article reviews the history, philosophy, therapeutic use, possible mechanisms of action, and literature pertaining to its use for this indication. For moxibustion, moxa can be rolled into stick form, placed directly on the skin, or placed on an acupuncture needle and ignited to warm acupuncture points. Studies have demonstrated that moxibustion may promote cephalic version of breech presentation and may facilitate external cephalic version. However, there is currently a paucity of research on the effects of moxibustion on cephalic version of breech presentation, and thus there is a need for further studies. Areas needing more investigation include efficacy, safety, optimal technique, and best protocol for cephalic version of breech presentation.
Chapter
Acupuncture is an ancient needling modality within Traditional Chinese Medicine used for chronic pain management. Western biophysical and Chinese meridian theory views of pain differ, and so do their respective management practices. The reversible effect of naloxone on the acupuncture induced analgesia is well known. Research has also shown correlations between acupuncture and its effect on the peripheral nerve endings, connective tissue, neurotransmitters, and inflammatory mediators. Centrally, studies with functional imaging and dynamic quantitative sensory testing substantiate the modulatory role of acupuncture in the “wind-up” phenomenon of spinal wide dynamic range neurons and different brain areas related to pain perception and modulation. Despite this increased understanding in the mechanisms and the analgesic efficacy of acupuncture, controversy continues to evolve around the issues of placebo effect and its potential therapeutic role in the main stream medicine.
Article
Purpose The purpose of this study was to follow the treatment of acupuncture combined with moxibustion with the fetus in breech presentation and to explore the correlation between acupuncture, moxibustion and fetal movement. Methods Participants were pregnant women between 28-37 weeks gestational age, having a normal pregnancy until the diagnosis of fetal breech position, and wanting to receive acupuncture in combination with moxibustion. Mental and physical reactions, common pregnancy complaints, and fetal movements before and after the treatment were analyzed. The number of fetal movements was measured using Fetal Movement Acceleration Measurement (FMAM) as an objective index. Results A total of 12 women were eligible for inclusion (11 primiparas and one multipara) and the average age was 32.7 years. There were 24 treatments given to each participant. On each occasion all participants reported an increased warmth in their hands and feet. On 22 out of 24 treatments (91.7%), the participants stated they felt relaxed and sleepy post treatment. Participants felt no adverse effects post-treatment. Frequency of "cramping of feet" and "irritations" before treatments, significantly decreased post-treatment ("cramping of feet" z=-2.53, p=.011, "irritations" z=-2.00, p=.046; Wilcoxon signed-rank test). The cephalic version group comprised eight participants (66.7%); the breech presentation group whose fetus remained in the breech position even after treatment contained four participants (33.3%). The time from a breech presentation diagnosis to the start of treatment was as follows: the cephalic version group was an average of 8.6 days and the breech presentation group was an average of 27.3 days. Therefore, the cephalic version presentation group had a significantly shorter period than the breech presentation group (t =-3.7, p=.02) in seeking treatment. The cephalic version group was at an average of 31.5 weeks gestational age, whereas the breech presentation group was an average of 34.1 weeks gestational age for commencement of treatment. The cephalic version group began treatment substantially earlier, than the breech presentation group (t=-2.4, p=.04). The FMAM monitored fetal movements 20 minutes before treatment, again during the treatment and finally 20 minutes after the treatment. During treatment, the cephalic version group moved 173.71 times/hr, compared with the breech presentation group at 105.63 times/hr which was a significant difference (t=2.78, p=.02). Overall, fetal movements increased more "during treatment", or "20 minutes after treatment" in the cephalic version group. Conclusion Post-treatment, participants with the fetus in breech presentation felt a warmth of their hands and feet, were more relaxed and reported feeling sleepy. "Cramping of feet" and "irritations" felt by participants significantly decreased after treatment. A fetus position conversion rate was 66.7%. The cephalic version group started treatment an average of 8.6 days from diagnosis of breech presentation, and by an average of 31.5 weeks gestational age. In the cephalic version group, the fetal movement increased "during treatment" and "20 minutes after treatment". There were no adverse effects reported during these treatments.
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Article
Background: Several studies have investigated the efficacy of moxibustion with or without acupuncture for fetal version, but the results are discordant. Meta-analyses pointed out the need for robust, methodologically sound, randomized controlled trials. Objective: The objective of this study was to assess the effectiveness of acupuncture with fire needling on acupoint BL67 for version of breech presentation. Study design: This was a randomized, sham-controlled, single-blinded trial, which took place in Strasbourg teaching maternity hospital, France. A total of 259 patients between 32 and 34 weeks of gestation have been randomized and analyzed. Patients were randomized to either acupuncture with fire needling or sham group, and were analyzed in their initial allocation group. Statistical analysis was conducted using Bayesian methods, in univariate analysis and in multivariate analysis after adjustment on parity. Results: The primary outcome was the rate of cephalic presentations at ultrasound examination performed between 35 and 36 weeks of gestation. A total of 49 (37.7%) fetuses were in cephalic presentation in the acupuncture group, versus 37 (28.7%) in the sham group: RR 1.34 [0.93-1.89], Pr RR>1=94.3%. After adjustment on parity, the acupuncture did not increase the rate of fetal cephalic version: OR 1.47 [0.84-2.42], Pr OR>1=90.3%. Conclusions: Our study suggests that acupuncture with fire needling on acupoint BL67 does not promote fetal cephalic version. Further studies might investigate effectiveness of other protocols of acupuncture. Randomization should be stratified for nulliparous and parous patients.
Article
Objective: To evaluate the efficacy of acupuncture and moxibustion (acup-moxi) therapy for breech presentation. Methods: We electronically searched The Cochrane Library (Issue 1, 2008), PubMed (1980 to Mar. 2008), MEDLINE (1966 to 2008), Ovid EBM Database (1991 to 2008), CBMdisc (1978 to Mar. 2008), VIP (1989 to Mar. 2008), CNKI (1979 to Mar. 2008), and WangFang Database (1983 to Mar. 2008), as well as handsearched seven traditional Chinese medicine journals to obtain randomized control trials (RCTs) about acup-moxi for breech presentation. Quality assessment was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1. Meta-analyses were performed for the results of homogeneous studies using RevMan 5.0 software. Results: Eight RCTs involving 1 341 patients met the inclusion criteria. Five trials were of relatively high quality and 3 were of low quality. The pooled analysis of six trials showed that acup-moxi was superior in cephalic presentation with RR=1.38, and 95%CI 1.20 to 1.58. Conclusion: Acup-moxi can increase the successful rate of cephalic presentation in the treatment of breech presentation compared with no (routine care) or knee-chest position treatment.
Article
When I first had the vision for this text, which was even before writing Shiatsu for Midwives, I wanted it to be a ' Bible ' for bodyworkers. It would be the bodywork equivalent of Mayes Midwifery. It would include everything that a bodyworker could possibly need to inform their practice! After 6 years of writing, however, I now realise how ambitious a plan that was. Mayes Midwifery is in its thirteenth edition and has been enriched over many years by the contributions and experience of numerous practitioners. This is only the first edition of this text, but none the less I have endeavoured to enrich it through the contributions of several workers and experts in the field. I offer it humbly as a textbook on bodywork which has more depth than any texts published on this subject so far, but which I am sure can be developed and improved.
Chapter
Moxibustion has been a part of acupuncture practice for 1,000 years, and the mechanisms of this traditional technique need scientific investigation and explanation. Up to the present, there has been no consensus of opinion on the mechanism of action which results in moxibustion’s therapeutic effects in clinical settings. This chapter presents information on recent advances in the understanding of the mechanism of moxibustion’s effect from the following three aspects: pharmacological action, thermal effect, and infrared physical properties. Previous studies have shown that there are many constituent elements in the smoke. In the literature on moxibustion’s effects, there is significant support for the proposition that thermal effects play a key role in the therapeutic benefits of moxibustion. According to this theory, the moxibustion effect is mainly due to the warm–hot (thermal) stimulative effect of burning moxa. However, this thermal effect hypothesis has been challenged by researchers who question that this effect contributes to moxibustion’s therapeutic benefits. Various studies indicate that the nonthermal action may affect the therapeutic effects significantly. Based on analysis of infrared radiation, the therapeutic effect produced by a traditional moxa stick may be the result of potent thermal action. The effects of indirect moxibustion with traditional media result both from thermal action and infrared radiation resonance between indirect moxibustion and acupuncture points. The apparatus with specific wavelength of infrared radiation similar to that of human acupoint was effective in rabbits with bradycardia and patients having osteoarthritis of knee. It should be further promoted in clinical application. Lastly, we will comment on several unsolved issues and future directions of the research concerning moxibustion treatment.
Article
Objectives : The objective of this study is to report the efficacy of acupuncture and moxibustion for the treatment of fetal breech presentation. Methods : We searched papers in PubMed, using the keywords "breech and moxibustion" and "breech and acupuncture". Search range includes randomized clinical trials(RCTs), controlled clinical trials(CCTs), case reports, and case series. Each original article must have an abstract in English. Finally, 7 RCTs from 102 were included in this review. Results : As a result of analyzing the 7 RCTs, five trials hold that moxibustion or acupuncture at BL67 has been shown to produce a positive effect for the correction of breech presentation and the other two trials indicated no beneficial effect. However, one of the latter could not come to a conclusion owing to the unsatisfactory compliance record of the participants. Conclusions : Acupuncture and moxibustion may be effective to correct fetal breech presentation. In this regard, the related clinical researches are worth to be conducted.
Article
Fetal malpresentation is an important cause of the high cesarean delivery rate in the United States and around the world. This includes breech, face, brow, and compound presentations as well as transverse lie. Risk factors include multiparity, previously affected pregnancy, polyhydramnios, and fetal and uterine anomalies. Appropriate management can reduce the need for cesarean delivery in some cases. This review discusses management options and focuses specifically on external cephalic version and vaginal breech delivery.
Article
Background: Acupuncture use in obstetrics has been increasing in Western medicine, especially to alleviate complications of pregnancy, the most important cause of maternal mortality worldwide. One quarter of maternal deaths are caused by complications in the third stage of labor, an interval between complete delivery of the baby and the complete expulsion of the placenta. Methods: This review analyzes the increased acupuncture use for pregnancy complications as a potential method of reducting maternal mortality during the third stage of labor. This overview focuses on acupuncture points and techniques to manage the third stage of labor and help patients with retained placentas. Passive (or expectant) management of the third stage of labor is occasionally associated with massive obstetric hemorrhage, a major cause of maternal morbidity and mortality, especially in low-income countries. Conclusions: Active management of the third stage of labor has been shown to reduce the risk of postpartum hemorrhage. Use of acupuncture in the first and second stages of labor could lead to a faster separation of the placenta in the third stage of labor. The possible effects of acupuncture in cases of retained placentas may have significant implications for possible complications and final outcomes of labor. Further studies are needed for more conclusive results.
Article
Objective : To make comprehensive picture of clinical trials using moxibustion and their results by today, then help a strategy for moxibustion-derived clinical studies in the future. Methods : Surveyed literatures containing randomized controled clinical trial (RCT) from PubMed and Korean journals. Analysis was performed according to distribution mainly by study subject, target diseases, study design, and its efficacy. Results : Fifty two literatures were selected according to inclusion criteria of randomized controled clinical study. Moxibustion-derived RCT have been rapidly increased from 2003 since the first was published in China in 1992. The main subjects of RCT are associated with immunity, cancer, arthritis, chronic colitis and urogenital disorders, which are connected to cold-elated pathogenesis. The average number of subjects was 94, and direct-moxibustion was mainly applied. The control groups were set up by giving conventional therapy, herbal medicine, acupuncture or only observation. The most of RCTs showed positive results. Conclusions : This study would be helpful for designing or conducting RCTs to develop the scientific development of moxibustion.
Article
Full-text available
Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. Its effect may be through increasing fetal activity. However, no randomized controlled trial has evaluated the efficacy of this therapy. To evaluate the efficacy and safety of moxibustion on acupoint BL 67 to increase fetal activity and correct breech presentation. Randomized, controlled, open clinical trial. Outpatient departments of the Women's Hospital of Jiangxi Province, Nanchang, and Jiujiang Women's and Children's Hospital in the People's Republic of China. Primigravidas in the 33rd week of gestation with normal pregnancy and an ultrasound diagnosis of breech presentation. The 130 subjects randomized to the intervention group received stimulation of acupoint BL 67 by moxa (Japanese term for Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech presentation. The 130 subjects randomized to the control group received routine care but no interventions for breech presentation. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks' gestation and delivery. Fetal movements counted by the mother during 1 hour each day for 1 week; number of cephalic presentations during the 35th week and at delivery. The intervention group experienced a mean of 48.45 fetal movements vs 35.35 in the control group (P<.001; 95% confidence interval [CI] for difference, 10.56-15.60). During the 35th week of gestation, 98 (75.4%) of 130 fetuses in the intervention group were cephalic vs 62 (47.7%) of 130 fetuses in the control group (P<.001; relative risk [RR], 1.58; 95% CI, 1.29-1.94). Despite the fact that 24 subjects in the control group and 1 subject in the intervention group underwent external cephalic version, 98 (75.4%) of the 130 fetuses in the intervention group were cephalic at birth vs 81 (62.3%) of the 130 fetuses in the control group (P = .02; RR, 1.21; 95% CI, 1.02-1.43). Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.
Article
Objectives:We assessed fetal heart variability and activity using a computerized non-stress test (NST) during acupuncture plus moxibustion on the BL67 point. For comparison, the same changes were assessed during placebo acupuncture (minimal acupuncture) in the same subjects.
Article
Bei der heute routinemäßig durchgeführten Ultraschalluntersuchung in der Schwangerschaft wird sich für den Untersucher und die Patientin häufig die Diagnose einer Beckenendlage ergeben. Aus 4066 Einzelbestimmungen wurde eine Kurve ermittelt, die die relativen Anteile von Beckenendlagen, Kopflagen und Querlagen im Verlauf der Schwangerschaft angibt. Dabei zeigen sich deutliche, z. T. statistisch signifikante Unterschiede zwischen Erstund Mehrgebärenden in bezug auf die einzelnen Lagen. Die Auswertung mehrerer Ultraschallbefunde an ein und derselben Patientin erlaubt Aussagen über die Wahrscheinlichkèit der zu einem bestimmten Zeitpunkt der Schwangerschaft noch zu erwartenden Drehung von der Beckenendlage in die Kopflage. Hierbei zeigen sich deutliche Unterschiede zwischen Erst- und Mehrschwangeren: So beträgt die Chance einer Erstschwangeren mit Beckenendlage ihres Kindes in der 29. Woche, daß sich das Kind noch spontan in die Kopflage drehen kann, 32,1%, während es bei der Mehrschwangeren 70,2% Wahrscheinlichkeit für eine spontane Drehung sind. In der 33. Woche ist die Wahrscheinlichkeit bei der Erstgravida 15,5% gegenüber 57,5% bei der Mehrgravida. Ab der 37. Woche ist weder bei Erst-, noch bei Mehrschwangeren mit einer spontanen Drehung in die Kopflage zu rechnen. Ein Kind in Kopflage hingegen dreht sich in der 29. Woche bei einer Erstpara mit 0,6% Wahrscheinlichkeit in eine BEL; bei einer Mehrpara ist die Chance mit 2,3% deutlich höher. Jenseits der 33. Woche ist bei beiden Gruppen mit einer Drehung in die BEL nicht mehr zu rechnen. In je einer Tabelle werden - getrennt für Erst- und Mehrschwangere - die Wahrscheinlichkeiten der Drehung bei BEL und Kopflagen für die 13.-41. Schwangerschaftswoche angegeben, so daß der untersuchende Arzt die Patientin exakt über die Wahrscheinlichkeit einer noch zu erwartenden Drehung in die »richtige« Lage (und umgekehrt) informieren kann: Tab. 3. Die häufigste (und somit wohl physiologische) Drehung ist die in die Kopflage, die bis zur 37. Schwangerschaftswoche abgeschlossen ist. Danach ist mit spontanen Drehungen nicht mehr zu rechnen.
Article
A prospective longitudinal investigation of spontaneous cephalic version from breech presentation in the last trimester is reported. All pregnancies were assessed with ultrasound in the 32nd week of gestation, and were thereafter checked weekly. Of the 310 singleton breech presentations identified at 32 weeks, spontaneous cephalic version occurred in 177 (57%) while breech presentation persisted in 133 patients (43%). Of 140 patients with a breech presentation at delivery 95% were already presenting by the breech in the 32nd week. Spontaneous cephalic version was less likely in pregnancies with extended fetal legs, low birth-weight, short umbilical cord and primiparity.
Article
Now that ultrasonography is a routine examination in pregnancy, breech presentations are frequently diagnosed. On the basis of 4066 individual examinations a graph was drawn indicating the relative frequency of breech, vertex and transverse presentations in the course of pregnancy. There are clear, and in some cases statistically significant differences between primiparae and multiparae with regard to the individual presentations. The analysis of several ultrasonographic examinations of one and the same patient makes a prediction possible of the likelihood of the foetus moving from breech to vertex presentation in a particular week of the pregnancy. Here there are clear differences between primiparae and multiparae: thus, the chance that a foetus in breech presentation in the 29th week will move spontaneously into vertex presentation in a primipara is 31.1%, while the degree of probability in multipara is 70.2%. In the 33rd week the probability is 15.5% in primiparae, as opposed to 57.5% in multiparae. From the 37th week on, spontaneous movement into vertex presentation is no longer likely to occur, in either primiparae or multiparae. In the 29th week, on the other hand, the likelihood of a foetus in vertex presentation moving into breech presentation in a primiparae is 0.6%, while in a multiparae it is considerably higher, at 2.3%. From the 33rd week on there is no likelihood of spontaneous movement into breech presentation in either group. Two tables, for primiparae and multiparae, respectively, show the likelihood of movement from one presentation to the other between the 13th and 41st weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Variable rates of external cephalic version (ECV) success in late pregnancy and of spontaneous version have been reported for different population groups. An ECV attempt by one operator in 80 patients beyond 36 weeks gestation was successful less frequently in white nulliparous patients and in those with lateral or cornual placental situation. A similar influence of ethnic and other variables was found on the spontaneous version rate in 108 patients in whom no ECV was attempted. Despite population differences in ECV success rates, the ratio of successful ECV to spontaneous version in reported randomized control trials is consistent at about 3:1.
Article
Our purpose was to study the safety and efficacy of external cephalic version before term (37 weeks' gestation). We retrospectively reviewed 114 pregnancies in 110 women at 30 to 41 weeks' gestation who had a total of 133 attempts at external cephalic version. Seventy-nine percent of the versions performed before the thirty-seventh week and 53% performed during or after the thirty-seventh week were successful. After adjustment parity and body mass index, a version performed before the thirty-seventh week was 27 times more likely to be successful than if performed during or after the thirty-seventh week. Ninety-nine percent of the successful versions were delivered with a vertex presentation, and of these only 16% required cesarean delivery. External cephalic version is safe and successful if performed before 37 weeks' gestation, hence substantially reducing the rate of cesarean section among nonvertex presentations and reducing the risks associated with breech delivery.
Article
Our aim was to investigate whether external cephalic version performed near term increases the concentration of cell-free fetal deoxyribonucleic acid in maternal plasma. Forty-five patients who had singleton male fetuses and were undergoing external cephalic version at or beyond 36 weeks of gestation were recruited during a 20-month period. Maternal venous blood samples were taken before and within 10 minutes after external cephalic version. Deoxyribonucleic acid was extracted from the plasma samples. The amount of fetal deoxyribonucleic acid was quantified by means of the SRY gene on the Y chromosome as a fetal marker. The change in SRY gene concentration before and after external cephalic version was compared by paired sample t test. There was a significant increase in the concentration of fetal deoxyribonucleic acid in maternal serum after external cephalic version (before, 296 +/- 209 copies per milliliter; after, 369 +/- 228 copies per milliliter; P =.014). This increase in the concentration of deoxyribonucleic acid was most profound among the nulliparous patients after a successful version and in the presence of a posterior placenta. The location of the placenta was found to be the most significant factor accounting for the change in the deoxyribonucleic acid concentration. External cephalic version near term imposed a significant disturbance to the maternalplacental interface. Fetal deoxyribonucleic acid is a sensitive marker that is useful in the assessment of subclinical fetal-maternal hemorrhage.
Article
For 3-4% of pregnancies, the fetus will be in the breech presentation at term. For most of these women, the approach to delivery is controversial. We did a randomised trial to compare a policy of planned caesarean section with a policy of planned vaginal birth for selected breech-presentation pregnancies. At 121 centres in 26 countries, 2088 women with a singleton fetus in a frank or complete breech presentation were randomly assigned planned caesarean section or planned vaginal birth. Women having a vaginal breech delivery had an experienced clinician at the birth. Mothers and infants were followed-up to 6 weeks post partum. The primary outcomes were perinatal mortality, neonatal mortality, or serious neonatal morbidity; and maternal mortality or serious maternal morbidity. Analysis was by intention to treat. Data were received for 2083 women. Of the 1041 women assigned planned caesarean section, 941 (90.4%) were delivered by caesarean section. Of the 1042 women assigned planned vaginal birth, 591 (56.7%) delivered vaginally. Perinatal mortality, neonatal mortality, or serious neonatal morbidity was significantly lower for the planned caesarean section group than for the planned vaginal birth group (17 of 1039 [1.6%] vs 52 of 1039 [5.0%]; relative risk 0.33 [95% CI 0.19-0.56]; p<0.0001). There were no differences between groups in terms of maternal mortality or serious maternal morbidity (41 of 1041 [3.9%] vs 33 of 1042 [3.2%]; 1.24 [0.79-1.95]; p=0.35). Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups.
Article
Breech presentation was successfully corrected by stimulating acupuncture points with moxibustion or low-frequency electrical current. Only patients with breech pregnancies at the 28th week or later were entered into the study. With moxibustion treatment, the control group had a spontaneous correction rate of 165/224 (73.66%), and the treatment group had a correction rate of 123/133 (92.48%) (P<0.0001, x2 test). With low-frequency percutaneous electrical stimulation, the correction rate was 20/941 (83.87%) in the control group and 171/191 (89.52%) in the treatment group (P=0.094, x2 test). The controls in the moxibustion study did no exercises and received no external manipulation to correct breech presentation whereas those in the electrical stimulation study experienced both. Acupuncture stimulation, especially with moxibustion, is expected to serve as a safe and effective modality in the management of breech presentation in a clinical setting.
Article
We assessed fetal heart variability and activity using a computerized non-stress test (NST) during acupuncture plus moxibustion on the BL67 point. For comparison, the same changes were assessed during placebo acupuncture (minimal acupuncture) in the same subjects. Twelve pregnant women in the 33rd week of gestation, carrying singletons in the breech presentation were enrolled in the study. In a single-blind design, each woman received a first session of minimal acupuncture followed 1-2 days later by true acupuncture. During the sessions, women were monitored using computerized non-stress testing starting 20 minutes before the stimuli and continuing for 20 minutes after treatment. During true acupuncture a significant reduction in fetal baseline heart rate, and more accelerations and movement were observed. During minimal acupuncture, there were no significant changes in these variables. No signs of fetal distress or changes in short- or long-term variability were noted, and there were no uterine contractions. In our study population, acute application of acupuncture plus moxibustion did not cause fetal distress as assessed by either fetal heart rate decelerations or changes in either short- or long-term variability. Considering that the modifications in fetal movement and heart rate occurred in true but not during minimal acupuncture, we could consider that such changes are related to the effect of the acupuncture stimulation. The mechanisms leading to the cephalic version remain to be clearly established.