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Cardini F, Weixin H. Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial. JAMA. 1998;280(18):1580–1584. doi:10.1001/jama.280.18.1580
From the Jiangxi Women's Hospital, Nanchang, People's Republic of China (Dr Weixin). Dr Cardini is in private practice in Verona, Italy.
Context.— 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.
Objective.— To evaluate the efficacy and safety of moxibustion on acupoint BL 67
to increase fetal activity and correct breech presentation.
Design.— Randomized, controlled, open clinical trial.
Setting.— Outpatient departments of the Women's Hospital of Jiangxi Province,
Nanchang, and Jiujiang Women's and Children's Hospital in the People's Republic
Patients.— Primigravidas in the 33rd week of gestation with normal pregnancy and
an ultrasound diagnosis of breech presentation.
Interventions.— 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.
Main Outcome Measures.— 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.
Results.— 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).
Conclusion.— 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
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