Acupuncture in Postdate Pregnancy Management

Journal of Acupuncture and Meridian Studies

Neri I et al,  Jnl Acup Merid Studies, Vol 11, 5, October 2018, Pages 332-336

This randomised and controlled trial recruited 375 women who were 2 days past their due date for delivery. The group that received acupuncture were less likely to be induced than the group that received “usual care”

Abstract

Objectives: Pharmacological labor induction is obtained through prostaglandins application and/or oxytocin infusion; however, the use seems to be related to fetal and maternal side effects. Traditional Chinese Medicine advocates the use of acupuncture to soften the cervix and induce uterine contractions. The primary outcome was the rate of women admitted for labour induction in case of prolonged pregnancy at 41 + 5 weeks, and the secondary outcome was the rate of induction planning for other indications.

Methods: After obtaining informed consent, 375 undelivered women after 40 + 2 gestational age were enrolled for the study: 112 women received acupuncture and 263, routine care. Acupuncture was applied every odd day starting from 40 + 2 weeks up to 41 + 4 weeks. Women allocated to the control group received standard care. At 41 + 5 weeks, a pharmacological induction was planned.

Results: The rate of labor induction significantly differed between acupuncture and observation groups (19.6% vs. 38%; p < 0.01); in particular, women receiving acupuncture showed a lower rate of induction, indicating prolonged pregnancy (5.3% vs. 10.1%; p < 0.01).

As far as the pharmacological device is concerned, no differences were observed with regard to the prostaglandins use, whereas oxytocin infusion rate was lower in the acupuncture group than in the observation group.

Conclusions: The present study suggested that acupuncture applied at term of pregnancy seems to be effective in reducing the rate of labor induction which is performed for prolonged pregnancy at 41 + 5 weeks. Moreover, acupuncture also seems to be able to reduce oxytocin use; such a “saving” effect could play a role in childhood, considering that a recent study underlined the adverse effect of oxytocin on birth outcomes.


Effects of LI-4 and SP-6 Acupuncture on Labor Pain, Cortisol Level and Duration of Labor.

Journal of Acupuncture and Meridian Studies

Asadi N et al, J Acupunct Meridian Stud. 2015 Oct;8(5):249-54

This randomised and controlled trial using sham acupuncture found that true acupuncture reduced labour time but did not influence pain of labour.

Abstract

Nowadays, acupuncture is widely used to manage pain, and childbirth is a condition requiring appropriate pain management interventions. The efficacy of acupuncture in the management of labor pain has recently been studied, but the results are not satisfactory and conflicts exist. In this study, we investigated the effects of acupuncture on labor pain, serum cortisol level, and duration of labor. We conducted a randomized, single-blind, controlled trial that included 63 nulliparous women: 32 in the study group and 31 in the control group. Acupuncture was performed at the SP-6 and the LI-4 points in the study group, and sham acupuncture was performed at the same points in the control group. Pain scores and serum cortisol levels were measured before and after the intervention. Changes in these measures and in the duration of labor were compared between the groups. No significant variations in pain scores or serum cortisol levels were observed between the two control groups. However, the duration of labor was significantly lower (p < 0.001) in the group receiving real acupuncture. Our results show that acupuncture is significantly associated with a decreased duration of labor, even though it was no better than a placebo for the treatment of labor pain.


The effects of acupuncture during labour on nulliparous women: a randomised controlled trial.

Hantoushzadeh S et al, Aust N Z J Obstet Gynaecol. 2007 Feb;47(1):26-30.

Australian and New Zealand Journal of Obstetrics and Gynaecology

 A reduction in pain and in labour duration was observed in women receiving acupuncture in this trial which involved 144 women giving birth for the first time.

 Abstract

BACKGROUND: Acupuncture is as an ancient system of diagnosis and treatment. It is regarded as a complementary tool for pain management.

AIMS: To assess the effects of acupuncture on nulliparous women during labour with respect to pain, labour duration and maternal acceptability.

METHODS: One hundred and forty-four healthy nulliparous women in active phase were randomised into the study and control group, receiving real and minimal acupuncture, respectively. Visual analogue scale was used to assess pain. Objectives were to evaluate acupuncture effect on pain and labour duration and patients’ willingness to receive acupuncture for subsequent pregnancies.

RESULTS: Visual analogue scale pain score in the study group was lower after two hours. Active phase duration and the oxytocin units administered were lower in the study group. Study group patients had greater willingness to receive acupuncture again. No adverse effects were detected.

CONCLUSIONS: Acupuncture could reduce pain experience, active phase duration and oxytocin units. Patients were satisfied and no adverse effects were noted.


Acupuncture for Depression During Pregnancy: A Randomized Controlled Trial

Manber R et al, Obst and Gynec 2010, 115 (3) 511 - 520 Obstetrics and Gynecology

Since there is evidence that the use of antidepressants increases the risk of miscarriage and may have adverse effects on the fetus, there has been much interest in the use of acupuncture to treat depression which occurs in pregnancy.
A number of trials and systematic reviews of the effectiveness of acupuncture in the treatment of depression have been published over the last 5 years and a meta-analysis of these trials concluded that acupuncture is an effective treatment for depression. This trial looked specifically at depression in pregnancy and found that acupuncture was as effective as other standard treatments and worked more quickly.

 Abstract

Objective: To estimate the efficacy of acupuncture for depression during pregnancy in a randomized controlled trial.
Methods: A total of 150 pregnant women who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for major depressive disorder were randomized to receive either acupuncture specific for depression or one of two active controls: control acupuncture or massage. Treatments lasted 8 weeks (12 sessions). Junior acupuncturists, who were not told about treatment assignment, needled participants at points prescribed by senior acupuncturists. All treatments were standardized. The primary outcome was the Hamilton Rating Scale for Depression, administered by masked raters at baseline and after 4 and 8 weeks of treatment. Continuous data were analyzed using mixed effects models and by intent to treat.
Results: Fifty-two women were randomized to acupuncture specific for depression, 49 to control acupuncture, and 49 to massage. Women who received acupuncture specific for depression experienced a greater rate of decrease in symptom severity (P<.05) compared with the combined controls (Cohen’s d=0.39, 95% confidence interval [CI] 0.01–0.77) or control acupuncture alone (P<.05; Cohen’s d=0.46, 95% CI 0.01–0.92). They also had significantly greater response rate (63.0%) than the combined controls (44.3%; P<.05; number needed to treat, 5.3; 95% CI 2.8–75.0) and control acupuncture alone (37.5%; P<.05: number needed to treat, 3.9; 95% CI 2.2–19.8). Symptom reduction and response rates did not differ significantly between controls (control acupuncture, 37.5%; massage, 50.0%).
Conclusion: The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments of similar length and could be a viable treatment option for depression during pregnancy.


Moxibustion for breech presentation: significant new evidence

Smith C, Acupunct Med 2013;31:5-6 Acupuncture in Medicine

In this editorial Caroline Smith from University of Western Sydney, discusses recent findings and analysis (Cochrane Review) of treatment for breech presentation.

 Abstract

In this review Cochrane Database Syst Rev. 2012 May 16;(5), moxibustion was not found to reduce the number of non-cephalic presentations at birth compared with no treatment (p=0.45) however it resulted in decreased use of oxytocin before or during labour for women who had vaginal deliveries compared with no treatment (risk ratio (RR) 0.28, 95% CI 0.13 to 0.60) and was found to result in fewer non-cephalic presentations at birth compared with acupuncture (RR 0.25, 95% CI 0.09 to 0.72).

When combined with acupuncture, moxibustion resulted in fewer non-cephalic presentations at birth (RR 0.73, 95% CI 0.57 to 0.94), and fewer births by caesarean section (RR 0.79, 95% CI 0.64 to 0.98) compared with no treatment.

When combined with a postural technique, it was found to result in fewer non-cephalic presentations at birth compared with the postural technique alone (RR 0.26, 95% CI 0.12 to 0.56).


Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial

Vas J et al, Acupunct Med 2013;31:31-38 Acupuncture in Medicine

Moxa applied to an acupuncture point on the foot was shown in this trial to be more effective than other treatments in correcting breech presentation between week 33 and 35 of pregnancy.

 Abstract

Objective: To compare the effectiveness of additional moxibustion at point BL67 with moxibustion at a non-specific acupuncture point and with usual care alone to correct non-vertex presentation.

Methods: This was a multicentre randomised controlled trial in which 406 low-risk pregnant women with a fetus in ultrasound breech presentation, with a gestational age of 33–35 weeks, were assigned to (1) true moxibustion at point BL67 plus usual care; (2) moxibustion at SP1, a non-specific acupuncture point (sham moxibustion) plus usual care; or (3) usual care alone. The primary outcome was cephalic presentation at birth. Women were recruited at health centres in primary healthcare.

Results: In the true moxibustion group, 58.1% of the full-term presentations were cephalic compared with 43.4% in the sham moxibustion group (RR 1.34, 95% CI 1.05 to 1.70) and 44.8% of those in the usual care group (RR 1.29, 95% CI 1.02 to 1.64). The reduction in RR of the primary outcome in women allocated to the true moxibustion group compared with the usual care group was 29.7% (95% CI 3.1% to 55.2%) and the number needed to treat was 8 (95% CI 4 to 72). There were no severe adverse effects during the treatment.

Conclusions: Moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. We believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus.


Electroacupuncture for cervical ripening prior to labor induction: a randomized clinical trial

Gribel G et al, Arch Gynecol Obstet (2011) 283:1233–1238 Archives Gynecology and Obstetrics

Two groups of women had their labours induced with either electroacupuncture or with prostaglandins. In both groups labour was successfully induced however the electroacupuncture group experienced significantly fewer obstetric complications including caesarian sections.

 Abstract

Purpose: The present study was aimed to compare the effects of the use of electroacupuncture and misoprostol in inducing labor in patients with Bishop score7 and to observe the characteristics of labor in both methods.

Methods: 67 pregnant women with Bishop score 7, single cephalic presentation with gestational age confirmed by first-trimester ultrasound, reactive cardiotocography, and amniotic fluid volume and estimated fetal weight within the respective normal ranges for gestational age were selected. They were randomized into 2 groups: electroacupuncture (AC) or misoprostol (M).

Results: There were no significant differences regarding age, gestational age, fetal weight, parity, Bishop score, or indication for induction. Labor was the main outcome, which was obtained in both groups without significant difference regarding frequency (p = 0.07) and time of induction (p = 0.29). Absence of obstetric complication, higher duration of labor (p = 0.036), and tendency to a higher satisfaction of the patients (p = 0.046) were observed among patients of group AC. Higher frequency of cesarean sections (p = 0.014) and obstetric complications (9.3%) were observed among patients of group M.

Conclusions: Our results showed that electroacupuncture can be used to obtain cervical ripening, with similar results as compared with misoprostol, with a significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications.


Cost-effectiveness of breech version by acupuncture-type interventions on BL 67, including moxibustion, for women with a breech foetus at 33 weeks gestation: a modelling approach

Van den Berg I et al, Complement Ther Med. 2010 Apr;18(2):67-77. Complementary therapies in medicine

The use of acupuncture and moxabustion on women presenting with breech babies at week 33 was assessed in this large restrospective Dutch study. Acupuncture was shown to reduce the number of breech presentations at term, thus reducing the number of caesarean sections.

Abstract

Objectives: To assess, using a modelling approach, the effectiveness and costs of breech version with acupuncture-type interventions on BL67 (BVA-T), including moxibustion, compared to expectant management for women with a foetal breech presentation at 33 weeks gestation.

Design: A decision tree was developed to predict the number of caesarean sections prevented by BVA-T compared to expectant management to rectify breech presentation. The model accounted for external cephalic versions (ECV), treatment compliance, and costs for 10,000 simulated breech presentations at 33 weeks gestational age. Event rates were taken from Dutch population data and the international literature, and the relative effectiveness of BVA-T was based on a specific meta-analysis. Sensitivity analyses were conducted to evaluate the robustness of the results.

Main Outcome Measures: We calculated percentages of breech presentations at term, caesarean sections, and costs from the third-party payer perspective. Odds ratios (OR) and cost differences of BVA-T versus expectant management were calculated. (Probabilistic) sensitivity analysis and expected value of perfect information analysis were performed.

Results: The simulated outcomes demonstrated 32% breech presentations after BVA-T versus 53% with expectant management (OR 0.61, 95% CI 0.43, 0.83). The percentage caesarean section was 37% after BVA-T versus 50% with expectant management (OR 0.73, 95% CI 0.59, 0.88). The mean cost-savings per woman was euro 451 (95% CI euro 109, euro 775; p=0.005) using moxibustion. Sensitivity analysis showed that if 16% or more of women offered moxibustion complied, it was more effective and less costly than expectant management. To prevent one caesarean section, 7 women had to use BVA-T. The expected value of perfect information from further research was euro0.32 per woman.

Conclusions: The results suggest that offering BVA-T to women with a breech foetus at 33 weeks gestation reduces the number of breech presentations at term, thus reducing the number of caesarean sections, and is cost-effective compared to expectant management, including external cephalic version.


Acupuncture for pelvic and back pain in pregnancy: a systematic review.

Ee CC et al, 2008 Am J Obstet Gynecol Mar;198(3):254-9. American Jnl Obstetrics and Gynecology

This review of 3 trials examining treatment of back and pelvic pain in pregnancy concludes that acupuncture, as an adjunct to standard treatment, is superior to standard treatment alone and physiotherapy.

 Abstract

The objective of our study was to review the effectiveness of needle acupuncture in treating the common and disabling problem of pelvic and back pain in pregnancy. Two small trials on mixed pelvic/back pain and 1 large high-quality trial on pelvic pain met the inclusion criteria. Acupuncture, as an adjunct to standard treatment, was superior to standard treatment alone and physiotherapy in relieving mixed pelvic/back pain. Women with well-defined pelvic pain had greater relief of pain with a combination of acupuncture and standard treatment, compared to standard treatment alone or stabilizing exercises and standard treatment. We used a narrative synthesis due to significant clinical heterogeneity between trials. Few and minor adverse events were reported. We conclude that limited evidence supports acupuncture use in treating pregnancy-related pelvic and back pain. Additional high-quality trials are needed to test the existing promising evidence for this relatively safe and popular complementary therapy.


Acupuncture to treat nausea and vomiting in early pregnancy: a randomized controlled trial

Smith C et al, Birth, 2002, (1) 1-9

 Nearly 600 women in their first trimester of pregnancy who were suffering from nausea, were treated with acupuncture once a week for four weeks. It was reported that acupuncture reduced nausea and dry retching from the second week of treatment compared with the control group who received no treatment.

 Abstract

BACKGROUND: Nausea and vomiting in early pregnancy are troublesome symptoms for some women. We undertook a single blind randomized controlled trial to determine whether acupuncture reduced nausea, dry retching, and vomiting, and improved the health status of women in pregnancy.

METHODS: The trial was undertaken at a maternity teaching hospital in Adelaide, Australia, where 593 women less than 14 weeks’ pregnant with symptoms of nausea or vomiting were randomized into 4 groups: traditional acupuncture, pericardium 6 (p6) acupuncture, sham acupuncture, or no acupuncture (control). Treatment was administered weekly for 4 weeks. The primary outcomes were nausea, dry retching, vomiting, and health status. Comparisons were made between groups over 4 consecutive weeks.

RESULTS: Women receiving traditional acupuncture reported less nausea (p < 0.01) throughout the trial and less dry retching (p < 0.01) from the second week compared with women in the no acupuncture control group. Women who received p6 acupuncture (p < 0.05) reported less nausea from the second week of the trial, and less dry retching (p < 0.001) from the third week compared with women in the no acupuncture control group. Women in the sham acupuncture group (p < 0.01) reported less nausea and dry retching (p < 0.001) from the third week compared with women in the no acupuncture group. No differences in vomiting were found among the groups at any time.

CONCLUSION: Acupuncture is an effective treatment for women who experience nausea and dry retching in early pregnancy. A time-related placebo effect was found for some women.