Burning Herbs to Correct Breech Presentation

Abstract & Commentary

Synopsis: Moxibustion, when used in primigravidas at 33 weeks gestation, is an effective therapy for inducing an increase in cephalic presentations.

Source: Cardini F, Weixin H. JAMA 1998;280: 1580-1584.

Moxibustion is a burning herb used to stimulate an acupuncture point beside the outer corner of the fifth toenail. To determine the efficacy and safety of moxibustion to promote version of fetuses in the breech presentation, Cardini and Weixin conducted a randomized, controlled, open clinical trial of primigravidas at 33 weeks gestation with a normal pregnancy and an ultrasound-confirmed diagnosis of breech presentation (n = 130). The moxibustion material in a "cigar-shaped roll" was applied for 30 minutes each day for seven days in the first 87 subjects, and twice daily in 43 subjects. Women in the control group (n = 130) received routine prenatal care. At 35 weeks, subjects in either group with a persistent breech presentation could elect to undergo external cephalic version (ECV). Because the beneficial effect of moxibustion may be through the stimulation of fetal activity, study subjects in both groups counted fetal movement for one hour each day.

At 35 weeks, 75.4% (98/130) of fetuses in the intervention group were in a cephalic presentation compared to 47.7% (62/130) of fetuses in the control group—a significant difference (P < 0.001). One patient in the intervention group had a failed ECV, while 19 of 24 ECVs in the control group were successful. Overall, even after ECV, the number of fetuses in a cephalic presentation remained significantly greater in the moxibustion-treated patients. Of note, fetal movements were significantly greater during the seven days of monitoring in the moxibustion patients, 48.45 per hour vs. 35.35 in the controls. Moxibustion treatment was not associated with adverse effects in the mother or neonate.

Cardini and Weixin conclude that moxibustion, when used in primigravidas at 33 weeks gestation, is an effective therapy for inducing an increase in cephalic presentations.

Comment by Steven G. Gabbe, MD

There has been a significant increase in the use of alternative therapies in the United States. A nationally conducted random household telephone survey revealed that more than 40% of adults questioned used at least one of 16 alternative therapies during the past year.

The study by Cardini and Weixin, performed at two hospitals in the People’s Republic of China, demonstrates that the herb moxibustion applied to a specific acupoint is associated with an increased likelihood of version in primigravid women treated during the 33rd week of pregnancy. Because there was an associated increase in fetal movement during the first week of treatment, this effect was thought to be the mechanism for the change in fetal position. Of note, the cesarean delivery rate was no different for either of the study groups—approximately 35% with most for cephalopelvic disproportion. While the trial was randomized and controlled, it was not blinded. Nevertheless, this report provides an interesting and alternative approach to the treatment of a common obstetrical problem.