Is moxibustion beneficial for primigravidae women with singleton breech presentation comparing with no extra treatment at 33th weeks of gestation?
Date of publication of the systematic review: April 2005
Design
Systematic review of randomized controlled trials (RCTs).
Participants
260 primigravidae women at 33 weeks’ gestation with a singleton breech presentation confirmed by ultrasound and normal fetal biometry. The reviewers did not state the age range of the women.
Intervention
Moxibustion to the acupuncture point Bladder 67 (BL67) (Chinese name Zhiyin) bilaterally at once or twice daily for 30 minutes (15 minutes each side) for 7 days. Women with breech presentation at 35 weeks could undergo external cephalic version (ECV).
Comparator
Comparison: Moxibustion versus no treatment.
Major Outcomes
Outcome 1:Caesarean section rate;
Outcome 2:Need for ECV (defined as breech presentation at the end of trial intervention).
Settings
The included trials were conducted in mainland. The reviewers did not state whether the trials were conducted in inpatient or outpatient settings.
Comparison    Moxibustion versus no treatment
Main Results
Compared to no treatment, moxibustion did not show significant reduction of caesarean section rate (relative risk reduction (RRR): 2%, 95% CI: -36% to 29%), but significantly reduced the need for external cephalic version (RRR: 53%, 95% CI: 34% to 67%).
Comparison: Moxibustion versus no treatment in women with breech presentation
Outcomes (units) No. of studies (Total number of participants) No. of events/No. of participants Heterogeneity test (I2) RRR (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 1 (260) 46/130 47/130 Not applicable as there is only 1 study. 2% (-36% to 29%) High
2 (NA) 1 (260) 32/130 68/130 Not applicable as there is only 1 study. 53% (34% to 67%) High
Keys: RRR: relative risk reduction; CI: confidence interval.
Comparison    Moxibustion versus no treatment
Main Results
Compared to no treatment, moxibustion did not show significant reduction of caesarean section rate (relative risk reduction (RRR): 2%, 95% CI: -36% to 29%), but significantly reduced the need for external cephalic version (RRR: 53%, 95% CI: 34% to 67%).
Comparison: Moxibustion versus no treatment in women with breech presentation
Outcomes (units) 1 (NA) 2 (NA)
No. of studies (Total number of participants) 1 (260) 1 (260)
No. of events/No. of participants Intervention 46/130 32/130
Comparator 47/130 68/130
RRR (95% CI) 2% (-36% to 29%) 53% (34% to 67%)
Overall quality of evidence* High High
Keys: RRR: relative risk reduction; CI: confidence interval.
Conclusion
Benefits
Compared to no treatment, moxibustion did not show clear benefit for women with breach presentation on the critical outcome of caesarean section rate, but can benefit them by reducing the need for cephalic version. For all outcomes, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
Exact number of adverse events was not reported by the reviewers. The main discomfort reported by women in both groups was pressure and tenderness in the epigastric region or in one of the hypochondriaepigastric crushing) attributed to the head of the breech baby pressing against maternal organs.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/15846688/
The synopsis is based on the following article:
Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database of Systematic
Reviews 2005, Issue 2. Art. No.: CD003928. DOI: 10.1002/14651858.CD003928.pub2.


* 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.