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Am Fam Physician. 2010;81(4):531

Background: The fetus presents in breech position in about 3 to 5 percent of deliveries. Elective cesarean delivery is often used to minimize perinatal morbidity. External cephalic version after 37 weeks of gestation may help avoid breech presentation and is reported to be successful in 30 to 80 percent of cases. This method may be painful for the mother and has the potential for umbilical cord entanglement or abruptio placentae. One study in China and another in Europe have reported that moxibustion at acupuncture point number 67 of the bladder meridian (acupoint BL 67) facilitated cephalic version without adverse effects in breech presentations between 28 and 35 weeks of gestation. The moxibustion used a burning stick containing mugwort (Artemisia vulgaris). Guittier and colleagues conducted a randomized controlled trial of moxibustion for cephalic version in a Swiss university obstetric unit.

The Study: All pregnant women between 34 and 36 weeks of gestation who presented with a single fetus in breech position were eligible for the study. Women with uterine malformations, placenta previa, or transverse lie were excluded. Fetal presentation was confirmed by ultrasonography. Eligible women were randomly assigned to moxibustion or expectant management. Moxibustion was carried out by placing the smoldering stick close to acupoint BL 67 (next to the outer corner of the fifth toenail) for 20 minutes. No more than 14 sessions were scheduled over a two-week period. Fetal position was assessed by ultrasonography at each hospital visit. The intervention was stopped when cephalic presentation was observed on ultrasonography or after two weeks of treatment.

The main outcome was the proportion of women with cephalic position at delivery or before attempted cephalic version. Secondary outcomes compared methods of delivery and perinatal and neonatal complications among the mothers and infants in both groups.

Results: The 106 women assigned to moxibustion were comparable to the 106 women assigned to the control group in all important variables, except that the intervention group included more nulliparous women. The mean number of moxibustion sessions was 10, with 54 percent of participants receiving 14 sessions. Three women assigned to the intervention group did not receive the intervention.

The percentage of fetuses in cephalic presentation at delivery or before scheduled version was 18 percent in the moxibustion group and 16 percent in the control group. Final presentation at delivery, mode of delivery, and outcomes for mothers and infants were similar between the two groups.

Conclusion: The authors conclude that moxibustion has no beneficial effect on cephalic version of fetuses in breech presentation.

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