Moxibustion and acupuncture to treat breech presentation

Breech presentation (opposite direction of the normal position of the fetus) is common in the mid-trimester of pregnancy, with an incidence of 3% to 4% by full term. Women with breech presentation have problems delivering vaginally.

Researchers from Beijing University, in China and the University of Troms, in Norway reviewed the literature on moxibustion, acupuncture, and other acupoint stimulations to correct breech presentation.

First, the details.

• 869 studies were screened, leading to 17 studies of 3499 women for review.
• 3 studies were rated as having good study design.
  • Clear description of the population, setting, treatment. and comparison groups
  • Appropriate measurement of outcomes
  • Appropriate statistical and analytical methods
  • No reporting errors
  • Fewer than 20% dropouts
  • Clear reporting of dropouts
  • Appropriate consideration and adjustment for potential confounding factors
• The data were combined for meta-analysis.
• When data were missing, the researchers contacted the study authors for more information.
• 14 of 17 studies used ultrasound to confirm the diagnosis of breech presentation.
  • Ultrasound is the most reliable test as it visualizes the fetus and reveals its position.
  • Other options include feeling the abdomen for the baby’s outline, listening to the baby’s heart, and vaginal exam.

And, the results.

• Moxibustion was significantly better than no treatment, but not more effective than the knee-chest position treatment — on hands and knees, with your butt raised.
  • There’s no solid evidence that knee-chest position works, according to Dr. Fred Coleman from the University of Oklahoma.
• Moxibustion + other treatments showed significant benefit.
• Laser stimulation was more effective than assuming the knee-chest position + pelvis rotating.
• Laser stimulation at Zhiyin (BL67) was significantly better than the knee-chest position treatment.
  • Zhiyin (BL67) is posterior to the corner of the nail on the side of the small toe.

The bottom line?
The authors concluded, “Moxibustion, acupuncture, and laser acupoint stimulation tend to be effective in the correction of breech presentation.”

They recommend that more study, specifically a multi-center study, is needed.

This review and meta-analysis raises several questions.

Ultrasound was used to confirm the diagnosis of breech presentation in only 14 of 17 studies.

• Why didn’t the researchers use the most accurate diagnostic tool to screen women for inclusion in the study?
• How reliable are the results of the 3 studies where less accurate methods were used to establish breech presentation at the start of the study?

The practice of calling authors after publication of their study to “fill in the blanks” is a practice that seems to be growing in popularity. Yet, its validity is questionable.

• Why weren’t the data included in the original study?
• Adding data after publication circumvents the peer review process.
• It opens the possibility of author bias in trying to remember details of old studies and the tendency to enhance results.

Finally, it’s not clear what a multi-center study (as suggested by these authors) would contribute to our knowledge.

• Rather, more high quality studies to erase doubt about the conclusions — considering only 3 of 17 were rated as “good” — might be a better goal.

3/14/09 17:04 JR