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Source: Cardini F, Weixin H. Moxibustion for correction of breech presentation: A randomized controlled trial. JAMA 1998;280:1580-1584.
Design and Setting: Randomized, controlled, open clinical trial in outpatient obstetrics departments of three hospitals in the People’s Republic of China.
Subjects: 260 primigravidas in the 33rd week of gestation with ultrasound diagnoses of breech presentation.
Treatment: Heat stimulation of acu-puncture point BL 67 (Zhiyin, beside the outer corner of the fifth toenail) by moxibustion (smoldering mugwort, an herb). The control group received routine care. All subjects were offered external cephalic version after two weeks.
Dose/Route/Duration: One treatment daily for seven days, followed by an additional seven days of treatment if breech presentation persisted.
Outcome Measures: Fetal movement counted by the mother during one hour each day for a week; number of cephalic presentations at 35 weeks and at delivery.
Results: The intervention group experienced a mean of 48.45 fetal movements vs. 35.35 in the control group. By the 35th week, 98/130 fetuses (75.4%) in the intervention group were cephalic vs. 62/130 fetuses (47.7%) in the control group. Although 24 subjects in the control group (19 successfully) and one in the moxibustion group (unsuccessfully) received external cephalic version, at birth 98/130 fetuses (75.4%) in the moxibustion group were cephalic, compared to 81/130 fetuses (62.3%) in the control group.
Funding: Centro di Orientamento Edu-cativo, Milan, Italy (a non-governmental, non-profit organization for cooperation) and the Commission des Communauts Europtennes, Brussels, Belgium.
Comments: Several trials have claimed some success with moxibustion version, but this is the first large, randomized, decently designed prospective study to test this intervention. The results support the use of the technique.
There are very few conditions that can be treated by acupuncture point stimulation at a single point; nausea and vomiting (see Alternative Therapies in Women’s Health, January 1999, pp. 9-11) and the turning of breech babies are exceptions.
A particularly nice thing about this intervention is its low cost and simplicity. The first application of moxa was done in the clinic, but after an instruction session the woman or her partner performed the rest of the treatments at home.
It is very unlikely that a trial performed in another country would affect clinical practice in the United States, but this trial should definitely be repeated. If the results are replicated, it would have the potential to prevent many cesareans and could be an easy intervention to incorporate into clinical practice.