Moxibustion
for Correction of Breech Presentation
A
Randomized Controlled Trial
Francesco
Cardini, MD; Huang Weixin, MD
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.
JAMA.
1998;280:1580-1584
Author/Article
Information
From the Jiangxi Women's Hospital, Nanchang, People's Republic
of China (Dr Weixin). Dr Cardini is in private practice
in Verona, Italy.
Corresponding author: Francesco Cardini, MD, Via Risorgimento
15, 37126 Verona, Italy (e-mail: cardinif@gardanews.it).
The
Chinese part of this research was financed by Centro di
Orientamento Educativo, Milan, Italy, a nongovernmental
nonprofit organization for cooperation, and by the Commission
des Communauts Europtennes, Brussels, Belgium.
We
particularly thank Franceseo Banfi, senior biostatician,
and Roberto Scognamiglio, data manager, Glaxo Research,
Verona, Italy, for statistical work; Murray Enkin, MD,
FRCSC, FRCOG, Departments of Obstetrics and Gynecology,
Clinical Epidemiology, and Biostatistics, McMaster University,
Toronto, Ontario, and Vittorio Basevi, MD, Verona, for
their precious advice regarding protocol and reporting
of the results; Qiu Lunxing, MD, Nanchang, China, for
his invaluable work in translation and supervision; Anthony
Steele, senior lecturer in medical English at the Medicine
University of Verona, Verona, Italy; and all staff directly
or indirectly involved in carrying out the research.
Reprints
not available from the author
