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Correction of nonvertex presentation with moxibustion

      To the Editors:
      With great interest we read the article by Vas et al.
      • Vas J.
      • Aranda J.M.
      • Nishishinya B.
      • et al.
      Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis.
      This systematic review and metaanalysis exhaustively discusses 7 studies comparing moxibustion and other methods for correction of nonvertex presentation. The major conclusion is that with regard to the correction of nonvertex presentation, there is a beneficial effect of moxibustion applied at the acupuncture point BL 67.
      However, this study has some limitations. The studies included in the review use a variety of control groups. The treatment in some of the control groups is only observational, so women in these groups get no treatment at all,
      • Cardini F.
      • Weixin H.
      Moxibustion for correction of breech presentation: a randomized controlled trial.
      • Neri I.
      • Airola G.
      • Contu G.
      • Allais G.
      • Facchinetti F.
      • Benedetto C.
      Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study.
      • Cardini F.
      • Lombardo P.
      • Regalia A.L.
      • et al.
      A randomised controlled trial of moxibustion for breech presentation.
      while women in other control groups get interventions such as postural inducement of version
      • Lin Y.P.
      • Zhang D.Q.
      • Hao Y.Q.
      • Duan X.W.
      • et al.
      Combination of moxibustion at point Zhiyin and knee-chest position for correction of breech presentation in 63 cases.
      • Yang F.Q.
      The comparison of knee chest position coordinated with moxibustion on Zhiyin with knee chest position alone for correcting breech presentation.
      • Chen
      Moxibustion on zhiyin acupoint for treatment of 80 cases with fetal malposition?.
      and acupuncture on BL 67.
      • Neri I.
      • De Pace V.
      • Venturini P.
      • Facchinetti F.
      Effects of three different stimulations (acupuncture, moxibustion, acupuncture plus moxibustion) of BL.67 acupoint at small toe on fetal behaviour of breech presentation.
      Besides, the treatment groups in the studies included in the review also use a variety of treatments. Some of the treatment groups only get moxibustion,
      • Cardini F.
      • Weixin H.
      Moxibustion for correction of breech presentation: a randomized controlled trial.
      • Cardini F.
      • Lombardo P.
      • Regalia A.L.
      • et al.
      A randomised controlled trial of moxibustion for breech presentation.
      • Chen
      Moxibustion on zhiyin acupoint for treatment of 80 cases with fetal malposition?.
      • Neri I.
      • De Pace V.
      • Venturini P.
      • Facchinetti F.
      Effects of three different stimulations (acupuncture, moxibustion, acupuncture plus moxibustion) of BL.67 acupoint at small toe on fetal behaviour of breech presentation.
      while other treatment groups get acupuncture
      • Neri I.
      • Airola G.
      • Contu G.
      • Allais G.
      • Facchinetti F.
      • Benedetto C.
      Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study.
      or knee-to-chest posture next to moxibustion.
      • Lin Y.P.
      • Zhang D.Q.
      • Hao Y.Q.
      • Duan X.W.
      • et al.
      Combination of moxibustion at point Zhiyin and knee-chest position for correction of breech presentation in 63 cases.
      • Yang F.Q.
      The comparison of knee chest position coordinated with moxibustion on Zhiyin with knee chest position alone for correcting breech presentation.
      It would have been more justified if the 2 studies with observational control groups vs moxibustion alone in the treatment groups were separated from the other studies. From these other studies, it would be justified to separate the studies in which moxibustion plus knee-to-chest posture is compared to only knee-to-chest posture. In this way, the results of the moxibustion treatment would have been more interpretable for clinical use.
      In March 2008, we published a systematic review of studies assessing the effectiveness of acupuncture-type interventions (moxibustion, acupuncture, or electroacupuncture) on acupuncture point BL 67 to correct breech presentation compared to expectant management, based on controlled trials.
      • van den Berg I.
      • Bosch J.L.
      • Jacobs B.
      • Bouman I.
      • Duvekot J.J.
      • Hunink M.G.
      Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: a systematic review.
      Several of the 9 studies reviewed overlap with those reviewed by Vas et al.
      • Vas J.
      • Aranda J.M.
      • Nishishinya B.
      • et al.
      Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis.
      Unfortunately, Vas et al
      • Vas J.
      • Aranda J.M.
      • Nishishinya B.
      • et al.
      Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis.
      were obviously unable to make a comparison with our review. By design we included only studies that used a control group without any intervention. We concluded that the current literature shows a beneficial effect of using acupuncture-type interventions on BL 67, including moxibustion, to induce correction of a breech presentation compared to expectant management.

      References

        • Vas J.
        • Aranda J.M.
        • Nishishinya B.
        • et al.
        Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis.
        Am J Obstet Gynecol. 2009; 201: 241-259
        • Cardini F.
        • Weixin H.
        Moxibustion for correction of breech presentation: a randomized controlled trial.
        JAMA. 1998; 280: 1580-1584
        • Neri I.
        • Airola G.
        • Contu G.
        • Allais G.
        • Facchinetti F.
        • Benedetto C.
        Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study.
        J Matern Fetal Neonatal Med. 2004; 15: 247-252
        • Cardini F.
        • Lombardo P.
        • Regalia A.L.
        • et al.
        A randomised controlled trial of moxibustion for breech presentation.
        BJOG. 2005; 112: 743-747
        • Lin Y.P.
        • Zhang D.Q.
        • Hao Y.Q.
        • Duan X.W.
        • et al.
        Combination of moxibustion at point Zhiyin and knee-chest position for correction of breech presentation in 63 cases.
        Zhongguo Zhen Jiu. 2002; 22: 811-812
        • Yang F.Q.
        The comparison of knee chest position coordinated with moxibustion on Zhiyin with knee chest position alone for correcting breech presentation.
        Sichuan Zhong Yi. 2006; 24: 106-107
        • Chen
        Moxibustion on zhiyin acupoint for treatment of 80 cases with fetal malposition?.
        Shaanxi Zhong Yi. 2007; 28: 334-335
        • Neri I.
        • De Pace V.
        • Venturini P.
        • Facchinetti F.
        Effects of three different stimulations (acupuncture, moxibustion, acupuncture plus moxibustion) of BL.67 acupoint at small toe on fetal behaviour of breech presentation.
        American Journal of Chinese Medicine. 2007; 35: 27-33
        • van den Berg I.
        • Bosch J.L.
        • Jacobs B.
        • Bouman I.
        • Duvekot J.J.
        • Hunink M.G.
        Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: a systematic review.
        Complement Ther Med. 2008; 16: 92-100

      Linked Article

      • Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis
        American Journal of Obstetrics & GynecologyVol. 201Issue 3
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          We searched systematically for randomized controlled trials, comparing moxibustion with a nonmoxibustion control group or other methods such as external cephalic version, postural methods, and acupuncture in databases, both Western and Chinese, up to June 2007. Six studies, with 1087 subjects and a high degree of heterogeneity, compared moxibustion vs observation or postural methods and reported a rate of cephalic version among the moxibustion group of 72.5% vs 53.2% in the control group (relative risk, 1.36; 95% confidence interval, 1.17–1.58); the number needed to treat was 5 (95% confidence interval, 4–7).
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