Is moxibustion plus acupuncture effective for reducing rate of breech presentations at 37 weeks of gestation, as compared to sham laser?
Date of publication of the randomized controlled trial: July 2014
Design
Randomized controlled trial (RCT).
Participants
328 women showed breech presentation by ultrasound examination, with gestational age ranging from 33±4 to 35±4 weeks of gestation (mean age: 30.2 years for intervention group, 30.7 years for control group).
Intervention
Six sessions of 20-minute moxibustion plus acupuncture were scheduled, once every 48 hours. In each session, the midwife provided a 10-minute treatment on each foot. Point BL67 was punctured at the external angle of each fifth toenail, a millimeter behind this angle. This point was then heated by moxibustion, at 3 or 4mm from the skin, with a part of the moxibustion stick placed on the needle.
Comparator
Comparison: Moxibustion plus acupuncture versus sham laser group. Sham laser group referred to intervention on the same acupuncture point with inactivated laser for 20 minutes.
Major Outcomes
Outcome 1: Rate of breech presentations at 37 ± 2 weeks of gestation.
Settings
This study was performed in an inpatient setting.
Comparison    Moxibustion plus acupuncture versus sham laser group
Main Results
Compared to sham laser, moxibustion plus acupuncture did not provide a significant reduction in the percentage of fetuses in breech presentation at 37 2/7 weeks of gestation. The rate of breech presentations in moxibustion plus acupuncture group was 72.0% compared with 63.4% in the sham laser group (p=0.10).
Comparison: Moxibustion plus acupuncture versus sham laser group in women showing breech presentation
Outcome (unit) No. of studies (Total number of participants) Rate of breech presentations /No. of participants Heterogeneity test ( I2) RR (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (%) 1 (328) 72.0/164 63.4/164 Not applicable as there is only 1 study. 1.13 (0.98 to 1.32) 0.10 Moderate
Keys: RR: relative risk; CI: confidence interval.
Comparison    Moxibustion plus acupuncture versus sham laser group
Main Results
Compared to sham laser, moxibustion plus acupuncture did not provide a significant reduction in the percentage of fetuses in breech presentation at 37 2/7 weeks of gestation. The rate of breech presentations in moxibustion plus acupuncture group was 72.0% compared with 63.4% in the sham laser group (p=0.10).
Comparison: Moxibustion plus acupuncture versus sham laser group in women showing breech presentation
Outcome (unit) 1 (%)
No. of studies (Total number of participants) 1 (328)
Rate of breech presentations /No. of participants Intervention 72.0/164
Comparator 63.4/164
RR (95% CI) 1.13 (0.98 to 1.32)
p value 0.10
Overall quality of evidence* Moderate
Keys: RR: relative risk; CI: confidence interval.
Conclusion
Benefits
Compared to sham laser, moxibustion plus acupuncture did not show significant reduction in the percentage of fetuses in breech presentation at 37 2/7 weeks of gestation. For outcome 1, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
Fourteen women (8.5%) in the moxibustion plus acupuncture group reported adverse effects after treatment. These included a painful burning sensation (n=7), blisters or other burn lesions (n=4), vasovagal syncope (n=1) and nausea and vomiting (n=2). There were no adverse events reported in the sham laser group.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/24901279
The synopsis is based on the following article:
Coulon C, Poleszczuk M, Paty-Montaigne MH, Gascard C, Gay C, Houfflin-Debarge V, Subtil D. Version of breech fetuses by moxibustion plus acupuncture: a randomized controlled trial. Obstet Gynecol. 2014 Jul;124(1):32-9.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.