Moxibustion for correction of breech presentation - A randomized controlled trial
Moxibustion for correction of breech presentation - A randomized controlled trial
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DOI：
10.1001/jama.280.18.1580
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发表时间：
1998-11-11
影响因子：
120.7
通讯作者：
Huang, WX
中科院分区：
文献类型：
--
作者：
Cardini, F;Huang, WX
背景。传统中医采用艾灸BL 67（指阴，位于第五趾甲外侧角旁）穴位（燃烧草药刺激穴位）来促进臀位胎儿的翻转。它的作用可能是通过增加胎儿活动。然而，没有随机对照试验评估这种疗法的疗效。目的：评价艾灸BL 67穴增加胎儿活动度、纠正臀位的有效性和安全性。随机、对照、开放临床试验。设置。-江西省妇女医院、南昌市妇女医院、九江市妇女儿童医院门诊部。Primigravidas在妊娠的第33周与正常妊娠和臀位介绍的超声诊断。随机分配至干预组的130名受试者接受艾草（日本术语为艾）卷刺激BL 67穴位7天，如果胎儿持续臀位，则额外治疗7天。130例随机分配到对照组的受试者接受常规护理，但不干预臀位。治疗2周后持续臀位的受试者可以在妊娠35周和分娩之间的任何时间进行头外倒转。由母亲在1周内每天1小时计算胎动数;在第35周和分娩时头先露的数量。干预组的平均胎动次数为48.45次，对照组为35.35次（P <0.001;差异的95%置信区间[CI]为10.56-15.60）。在妊娠第35周，干预组130例胎儿中有98例（75.4%）为头位，对照组130例胎儿中有62例（47.7%）为头位（P <0.001;相对危险度[RR]，1.58; 95%CI，1.29-1.94）。尽管对照组中有24例受试者和干预组中有1例受试者接受了头外倒转术，但98干预组130例胎儿中有75.4%出生时为头位，对照组130例胎儿中有81例（62.3%）出生时为头位（P = 0.02; RR，1.21; 95% CI，1.02-1.43）。在孕33周臀先露的孕妇中，艾灸1 ~ 2周可增加治疗期间的胎儿活动，并增加治疗期后和分娩时的头先露。
Context.-Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. Its effect may be through increasing fetal activity. However, no randomized controlled trial has evaluated the efficacy of this therapy.Objective.-To evaluate the efficacy and safety of moxibustion on acupoint BL 67 to increase fetal activity and correct breech presentation.Design.-Randomized, controlled, open clinical trial.Setting.-Outpatient departments of the Women's Hospital of Jiangxi Province, Nanchang, and Jiujiang Women's and Children's Hospital in the People's Republic of China.Patients.-Primigravidas in the 33rd week of gestation with normal pregnancy and an ultrasound diagnosis of breech presentation.Interventions.-The 130 subjects randomized to the intervention group received stimulation of acupoint BL 67 by moxa (Japanese term for Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech presentation. The 130 subjects randomized to the control group received routine care but no interventions for breech presentation. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks' gestation and delivery.Main Outcome Measures.-Fetal movements counted by the mother during 1 hour each day for 1 week; number of cephalic presentations during the 35th week and at delivery.Results.-The intervention group experienced a mean of 48.45 fetal movements vs 35.35 in the control group (P < .001; 95% confidence interval [CI] for difference, 10.56-15.60). During the 35th week of gestation, 98 (75.4%) of 130 fetuses in the intervention group were cephalic vs 62 (47.7%) of 130 fetuses in the control group (P < .001; relative risk [RR], 1.58; 95% CI, 1.29-1.94). Despite the fact that 24 subjects in the control group and 1 subject in the intervention group underwent external cephalic version, 98 (75.4%) of the 130 fetuses in the intervention group were cephalic at birth vs 81 (62.3%) of the 130 fetuses in the control group (P = .02; RR, 1.21; 95% CI, 1.02-1.43).Conclusion.-Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.