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

Ultrasound examination was performed before and after each moxibustion treatment to determine the fetal presentation. Treatment was discontinued when the fetus was found to be repositioned to cephalic presentation.

2) Low-Frequency Percutaneous Stimulation

The same acupuncture points as those used for moxibustion treatment were stimulated with low frequency (at 3 Hz) for 30 minutes at each time of treatment using ECG electrodes. Of 941 women with simple labor, treated at affiliated hospitals between April 1994 and July 1995, 191 with breech presentation after the 28th week of pregnancy received low-frequency stimulation. As controls, 1038 women with simple labor between April 1992 and March 1994 were examined. Of these controls, 217 showed breech presentation after the 28th week of pregnancy.

Results and Discussion

1) Moxibustion Treatment

Of the 133 women receiving moxibustion treatment, 123 (92.48%) underwent cephalic version. In the control group of 224 women, 165 (73.66%) underwent cephalic version. This difference in correction rate is highly significant (p [is less than] 0.0001, [x.sup.2] test). There were no differences in age, gestational age, ratio of primiparae to pluriparae, body weight, or height between the treatment and control groups (Table 1).

Table 1. Correction Rate for Breech Presentation
with or without Moxibustion Treatment

Moxibustion treatment

                Control group      Treated group    Significance

The rate of    59/1478 (3.99%)    36/1437 *2,51%)   p = 0.0238
breech                                              ([chi square]
delivery                                            test)

Correcting    165/224 (73.66%)   123/133 (92.48%)   p < 0.0001
rate                                                ([chi square]
                                                    test)

2) Low-Frequency Percutaneous Stimulation

Of the 217 women in the control group, 182 (83.87%) underwent cephalic version. Of the 191 women receiving acupuncture stimulation, 171 (89.52%) underwent cephalic version. This difference had a one-tailed significance of 0.094, almost reaching the 5% level. The reasons for the higher correction rate in this control group, compared with that seen for the moxibustion control group, are that women with breech presentation in the current control group were warmly encouraged to do knee-chest exercises during the period of the study of low-frequency stimulation, and their obstetricians specialized in external version correction of breech presentation. There were no differences in age, gestational age, ratio of primiparae to pluriparae, body weight, or height in the treatment and control groups.

The results of the present study suggest that stimulation of acupuncture points can increase the rate of cephalic version in breech pregnancies to around 90%, even after the 28th week (Tatum et al., 1985). Although stimulation of acupuncture points is known to be effective for many diseases, the mechanisms of correction of fetal presentation with acupoint stimulation remain obscure. Correction of fetal position with knee-chest exercises or external version is usually made while the uterus is being relaxed, because a tense uterus usually results in a low success rate and involves a high risk of complications. It was confirmed that stimulation of acupuncture points relaxed the myometrium, providing the fetus with a more movable condition. However, it should be further determined what mechanism is involved in the initiation of fetal movements. When the effects of acupoint stimulation on uterine muscular tonus were examined using a monitoring system in patients at the risk of premature birth, we observed the disappearance of uterine contraction, as shown in Figure 2. Moreover, the uterine artery and umbilical artery showed a temporary decrease in pulsatility index (PI) after acupoint stimulation, improving the fetal environment (Figure 3 and Figure 4). These changes seem to activate fetal movements, possibly causing cephalic version. When abdominal temperature was measured with a thermograph before and after acupoint stimulation, skin surface temperature was found to be increased by stimulation, indicating vascular dilatation and increased blood flow. Patients reported in our questionnaire research that they had no abdominal pain during moxibustion treatment, but rather felt comfortable warmth not limited to the abdomen, but in the entire body. They also reported a decrease in uterine tonus and an increase in fetal movements (Figure 5). Their blood pressure and pulse rate remained stable during acupoint stimulation (Figure 6). Thus we confirmed that stimulation of acupuncture points is a safe therapeutic modality, without inducing anxiety or any unpleasant feeling.