Moxibustion Treatment of Breech Presentation

American Journal of Chinese Medicine, Wntr, 2001 by Yoichi Kanakura, Kunio Kometani, Tetsurou Nagata, Kuniaki Niwa, Hiroshi Kamatsuki, Yasutaka Shinzato, Yasumoto Tokunaga

(Accepted for publication August 15, 2000)

Abstract: Breech presentation was successfully corrected by stimulating acupuncture points with moxibustion or low-frequency electrical current. Only patients with breech pregnancies at the 28th week or later were entered into the study. With moxibustion treatment, the control group had a spontaneous correction rate of 165/224 (73.66%), and the treatment group had a correction rate of 123/133 (92.48%) (P [is less than] 0.0001, [x.sup.2] test). With low-frequency percutaneous electrical stimulation, the correction rate was 20/941 (83.87%) in the control group and 171/191 (89.52%) in the treatment group (P=0.094, [x.sup.2] test). The controls in the moxibustion study did no exercises and received no external manipulation to correct breech presentation whereas those in the electrical stimulation study experienced both. Acupuncture stimulation, especially with moxibustion, is expected to serve as a safe and effective modality in the management of breech presentation in a clinical setting.

It is widely known that neonatal mortality and the incidence of neonatal asphyxia are higher in vaginal breech delivery than in cephalic delivery. Thus, cesarean section is often selected to deliver a breech (Cardini et al., 1991). However, because cesarean section is not perfectly safe (Cardini et al., 1991; Collea, 1980; Confino et al., 1985; Gimovsky et al., 1983), it is better to reposition a breech fetus to a cephalic position for normal vaginal delivery, if version can be performed safely (Kaneko, 1993; Kenneth et al., 1976; Kimura, 1973). Although breech fetuses often reposition spontaneously to a cephalic position up to the 30th to 32nd week of pregnancy, spontaneous cephalic version rarely occurs after this period of pregnancy. Traditionally, knee-chest exercises are done to aid spontaneous cephalic version. However, this technique cannot produce a high success rate. External version, which is a method of rotating a fetus positioned in a breech presentation using external force, may cause premature placental abruption or neonatal asphyxia (Kinoshita et al., 1974; Levinson et al., 1987), resulting in its infrequent use in recent years. These circumstances led us to investigate the correction of breech presentation by stimulation of acupuncture points, which is a technique that has been employed in China since ancient times (Lyons et al., 1978; Prichard et al., 1985; Sakamoto et al., 1992; Saling et al., 1975), and we carried out the present studies to determine whether acupoint stimulation is a safe and effective method of correcting breech presentation.

Methods

1) Moxibustion Treatment (study period: September 1992 to December 1996)

One hundred thirty-three pregnant women whose fetuses were determined to be in a breech presentation at the 28th week of pregnancy or later and who gave their consent to moxibustion treatment were entered to this study. Expected dates of their deliveries were between January 1993 and December 1996, during which period 1437 infants were delivered at our institute. The subjects consisted of 61 primigravidas and 72 multigravidas, with the mean age of 28.4 years.

A total of 1478 women with simple labor between January 1989 and December 1992 were used as controls, none of whom received moxibustion treatment because we had not yet initiated this treatment. Of these controls, 224 showed breech presentation after the 28th week of pregnancy.

Moxibustion treatment was given daily for 30 minutes until the breech presentation was corrected or confirmed to no longer have any effective response to moxibustion. In moxibustion treatment, 6 acupuncture points, including SP-6 (San-Yin-Chiao), B1-67 (Chih-Yin), and Ki-l (Yung-Ch'uan) on both right and left sides, were used (Figure 1). Moxa sticks were used for B1-67; Sennen-kyu was used for SP-6 (10 pieces were used on right and left sides); and Kamaya-kyu was used for Ki-l (10 pieces on right and left sides). Sennen-kyu is a piece of Moxa packed into a tube with a plinth, made of Japanese paper. Kamaya-kyu is developed to abate heat from burning Moxa by making a space between the Moxa and the skin.

[Figure 1 ILLUSTRATION OMITTED]

The acupuncture point B1-67 was selected because this point, located on the foot along the Yan bladder meridian, has been used for correction of abnormal fetal presentation, and it is said that moxibustion on this point alone is effective in presentation correction. In fact, one of the authors encountered a successful case of cephalic version, in which he instructed a husband to massage this point for his wife with breech presentation. This experience motivated the author to conduct the present studies.

SP-6 is an intersection of 3 Yin meridians for the spleen, kidney and liver on the foot. This point is important for female diseases. Like B1-67, SP-6 is also used for correction of abnormal fetal presentation.

Ki-l, a point on the foot kidney meridian, was selected because stimulation of this point increases vital energy and also strengthens uterine function. This point is also known to facilitate calmness (Tashiro et al., 1990; Takagi et al., 1980).