Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial | Pregnancy | JAMA | JAMA Network
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1.
Hickok DE, Gordon DC, Milberg JA, Williams MA, Daling JR. The frequency of breech presentation by gestational age at birth.  Am J Obstet Gynecol.1992;166:851-852.Google Scholar
2.
Hill LM. Prevalence of breech presentation by gestational age.  Am J Perinatol.1990;7:92-93.Google Scholar
3.
Hughey MJ. Fetal position during pregnancy.  Am J Obstet Gynecol.1985;153:885-886.Google Scholar
4.
Scheer K, Nubar J. Variation of fetal presentation with gestational age.  Am J Obstet Gynecol.1976;125:269-270.Google Scholar
5.
Bartlett D, Okun N. Breech presentation: a random event or an explainable phenomenon?  Dev Med Child Neurol.1994;36:833-838.Google Scholar
6.
Bartlett D, Piper M, Okun N, Byrne P, Watt J. Primitive reflexes and the determination of fetal presentation at birth.  Early Hum Dev.1997;48:261-273.Google Scholar
7.
Babkin PS, Ermolenko NA. The motor adaptation syndrome in the human fetus and its dynamics in newborns.  Zh Nevrol Psikhiatr Im S S Korsakova.1994;94:19-21.Google Scholar
8.
Rayl J, Gibson J, Hickok DE. A population-based case-untreated study of risk factors for breech presentation.  Am J Obstet Gynecol.1996;174:28-32.Google Scholar
9.
Sival DA. Studies on fetal motor behaviour in normal and complicated pregnancies.  Early Hum Dev.1993;34:13-20.Google Scholar
10.
Hofmeyr GJ. External cephalic version facilitation at term. In: Neilson JP, Crowther CA, Hodnett ED, Hofmeyr GJ, eds. The Cochrane Library: Pregnancy and Childbirth Module of the Cochrane Database of Systematic Reviews [database on disk and CD-ROM]. Oxford, England: Update Software; 1998.
11.
Cooperative Research Group of Moxibustion Version of Jangxi Province.  Studies of version by moxibustion on Zhiyin points. In: Xiangtong Z, ed. Research on Acupuncture, Moxibustion and Acupuncture Anesthesia . Beijing, China: Science Press; 1980:810-819.
12.
Cooperative Research Group of Moxibustion Version of Jangxi Province.  Further studies on the clinical effects and the mechanism of version by moxibustion. In: Abstracts of the Second National Symposium on Acupuncture, Moxibustion and Acupuncture Anesthesia; August 7-10, 1984; Beijing, China.
13.
Cardini F, Basevi V, Valentini A, Martellato A. Moxibustion and breech presentation: preliminary results.  Am J Chin Med.1991;19:105-114.Google Scholar
14.
Boos R, Hendrik HJ, Schmidt W. Das fetale Lageverhalten in der zweiten Schwangerschaftshalfte bei Geburten aus Beckenendlage und Schadellage.  Geburtsh Frauenheilkd.1987;47:341-345.Google Scholar
15.
Gottlicher S, Madjaric J. Die Lage der menschlichen Frucht im Verlauf der Schwangerschaft und die Wahrscheinlichkeit einer spontanen Drehung in die Kopflage bei Erst und Mehrgebarenden.  Geburtsh Frauenheilkd.1985;45:534-538.Google Scholar
16.
Gottlicher S, Madjaric J, Morgens KL, Mittags BEL. Ein Ammenmärchen?  Geburtsh Frauenheilkd.1989;49:363-366.Google Scholar
17.
Westgren M, Edvall H, Nordstrom L, Svalenius E. Spontaneous cephalic version of breech presentation in the last trimester.  Br J Obstet Gynaecol.1985;92:19-22.Google Scholar
18.
Cardini F, Marcolongo A. Moxibustion for correction of breech presentation.  Am J Chin Med.1993;21:133-138.Google Scholar
19.
Thorp Jr JM, Jenkins T, Watson W. Utility of Leopold maneuvers in screening formal presentation.  Obstet Gynecol.1991;78(3 pt 1):394-396.Google Scholar
20.
Engel K, Gerke-Engel G, Gerhard I, Bastert G. Fetomaternal macrotransfusion after successful internal version from breech presentation by moxibustion [in German].  Geburtsh Frauenheilkd.1992;52:241-243.Google Scholar
21.
Weng J, Peng G, Yuang H, Mao S, Zhang H. The morphological investigation of the correcting abnormal fetus position by acupuncture, moxibustion and laser irradiation in the point Zhiyin. In: Abstracts of the Second National Symposium on Acupuncture and Moxibustion and Acupuncture Anesthesia; August 7-10, 1984; Beijing, China.
22.
World Health Organization Regional Office for the Western Pacific.  Guidelines for Clinical Research on Acupuncture . Manila, Philippines: World Health Organization Regional Publications; 1995. Western Pacific Series No. 15.
Original Contribution
November 11, 1998

Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial

Author Affiliations

From the Jiangxi Women's Hospital, Nanchang, People's Republic of China (Dr Weixin). Dr Cardini is in private practice in Verona, Italy.

JAMA. 1998;280(18):1580-1584. doi:10.1001/jama.280.18.1580
Abstract

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 of China.

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 at delivery.

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