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The Cochrane Database of Systematic... May 2012Moxibustion (a type of Chinese medicine which involves burning a herb close to the skin) to the acupuncture point Bladder 67 (BL67) (Chinese name Zhiyin), located at the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Moxibustion (a type of Chinese medicine which involves burning a herb close to the skin) to the acupuncture point Bladder 67 (BL67) (Chinese name Zhiyin), located at the tip of the fifth toe, has been proposed as a way of correcting breech presentation.
OBJECTIVES
To examine the effectiveness and safety of moxibustion on changing the presentation of an unborn baby in the breech position, the need for external cephalic version (ECV), mode of birth, and perinatal morbidity and mortality for breech presentation.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (26 March 2012), MEDLINE (1966 to 1 August 2011), EMBASE (1980 to August 2011), CINAHL (1982 to 1 August 2011), MIDIRS (1982 to 1 August 2011) and AMED (1985 to 1 August 2011) and searched bibliographies of relevant papers.
SELECTION CRITERIA
The inclusion criteria were published and unpublished randomised controlled trials comparing moxibustion (either alone or in combination with acupuncture or postural techniques) with a control group (no moxibustion), or other methods (e.g. external cephalic version, acupuncture, postural techniques) in women with a singleton breech presentation.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed eligibility and trial quality and extracted data. The outcome measures were baby's presentation at birth, need for external cephalic version, mode of birth, perinatal morbidity and mortality, maternal complications and maternal satisfaction, and adverse events.
MAIN RESULTS
Six new trials have been added to this updated review. One trial has been moved to studies awaiting classification while further data are being requested. This updated review now includes a total of eight trials (involving 1346 women). Meta-analyses were undertaken (where possible) for the main and secondary outcomes. Moxibustion was not found to reduce the number of non-cephalic presentations at birth compared with no treatment (P = 0.45). Moxibustion 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% confidence interval (CI) 0.13 to 0.60). Moxibustion 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, moxibustion 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).
AUTHORS' CONCLUSIONS
This review found limited evidence to support the use of moxibustion for correcting breech presentation. There is some evidence to suggest that the use of moxibustion may reduce the need for oxytocin. When combined with acupuncture, moxibustion may result in fewer births by caesarean section; and when combined with postural management techniques may reduce the number of non-cephalic presentations at birth, however, there is a need for well-designed randomised controlled trials to evaluate moxibustion for breech presentation which report on clinically relevant outcomes as well as the safety of the intervention.
Topics: Acupuncture Points; Acupuncture Therapy; Breech Presentation; Female; Humans; Moxibustion; Pregnancy; Randomized Controlled Trials as Topic; Version, Fetal
PubMed: 22592693
DOI: 10.1002/14651858.CD003928.pub3 -
Gynecologie, Obstetrique, Fertilite &... Jan 2020
Topics: Breech Presentation; Delivery, Obstetric; Female; France; Humans; Obstetrics; Practice Guidelines as Topic; Pregnancy
PubMed: 31678564
DOI: 10.1016/j.gofs.2019.10.021 -
Congenital Anomalies Jul 2021Our study aimed to determine if congenital anomalies are associated with breech presentation at delivery. We conducted a nationwide, retrospective population-based...
Our study aimed to determine if congenital anomalies are associated with breech presentation at delivery. We conducted a nationwide, retrospective population-based record linkage study and analyzed all singleton births in Finland from 1996 to 2016 using the mandatory health register data collected by the Finnish Institute for Health and Welfare. We compared all major congenital anomalies detected during pregnancy, birth, or the first year of life according to the fetus's presentation at the time of delivery using X -square statistic and Student's t test. We adjusted the results for known risk factors for congenital anomalies to estimate adjusted odds ratios and 95% confidence intervals. Fetuses in breech presentation at delivery had an increased risk for congenital anomalies (6.5%) compared with fetuses in cephalic presentation (3.6%), P < .001. Breech presentation was associated with nearly all types of examined congenital anomalies. The strongest associations were observed with congenital deformities of the hip, the central nervous system, the respiratory system, and the musculoskeletal system. Our study supports the theory that breech presentation is, in many cases, a symptom of a fundamental problem in fetal morphogenesis or function. Neonates born in the breech presentation have a higher risk of congenital anomalies and should undergo a postnatal screening.
Topics: Adult; Breech Presentation; Congenital Abnormalities; Disease Susceptibility; Female; Finland; Humans; Incidence; Infant, Newborn; Population Surveillance; Pregnancy; Registries; Retrospective Studies; Risk Assessment; Risk Factors
PubMed: 33559256
DOI: 10.1111/cga.12411 -
European Journal of Obstetrics,... Dec 2020To compare maternal and perinatal outcomes, including neurodevelopmental results at 18 months of life, between term breech and cephalic deliveries.
OBJECTIVES
To compare maternal and perinatal outcomes, including neurodevelopmental results at 18 months of life, between term breech and cephalic deliveries.
STUDY DESIGN
In this longitudinal retrospective study of mothers seen at the Maternity and Paediatric University Hospital of the Canary Islands delivery unit from November 1, 2011, to October 31, 2012, we compared maternal and perinatal outcomes associated with breech or cephalic presentation of the foetus. A second analysis was performed to compare breech births, differentiating between whether a vaginal delivery attempt was made or if caesarean section (C-section) without labour had been directly scheduled. The psychomotor development of children 18 months after birth was assessed using the Haizea-Llevant scale.
RESULTS
A total of 130 breech deliveries were matched with 130 cephalic deliveries. No perinatal mortality occurred in either group. The C-section percentage was greater in the breech presentation group compared with the cephalic delivery group (72.3 % vs. 14.6 %; p < 0.001). Children in the breech presentation had a threefold increased risk for Apgar scores <7 at 1 min (OR 3.2; 95 % CI: 1.2-8.4; p = 0.016) compared with cephalic presentation. These differences disappeared 5 min after birth. No differences were observed in moderate to severe neonatal morbidity between the breech and cephalic presentation groups. There were no differences between groups in neurodevelopmental outcomes. Of 130 pregnancies with breech presentation, 79 (60.8 %) made a vaginal delivery attempt, and 51 (39.2 %) were planned C-sections. Women who attempted vaginal breech delivery were younger and had a history of previous pregnancy. Apgar scores <7 at 1 min were more frequent in the vaginal delivery attempt group (27.9 % vs. 5.9 %; p = 0.002). A high percentage of type III resuscitation (36.5 % vs. 14.3 %; p = 0.007) and Neonatology admission (22.8 % vs. 5.9 %; p = 0.013) was observed in the vaginal delivery attempt group. Except for Apgar scores <7 at 1 min, none of these associations was significant after adjusting for nulliparity and maternal age. The mode of delivery was not associated with moderate to severe perinatal outcomes.
CONCLUSION
The implementation of a specific protocol for selecting pregnant women with breech presentation as candidates for vaginal delivery achieved perinatal outcomes similar to births in cephalic presentation.
Topics: Breech Presentation; Cesarean Section; Child; Delivery, Obstetric; Female; Humans; Infant, Newborn; Pregnancy; Retrospective Studies; Spain
PubMed: 33130377
DOI: 10.1016/j.ejogrb.2020.10.020 -
American Journal of Obstetrics and... Mar 2014In 2011, 1 in 3 women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be lifesaving for the fetus, the mother, or both in certain...
In 2011, 1 in 3 women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be lifesaving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 through 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of these, as well as other, indications. For example, it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught. Additionally, improved and standardized fetal heart rate interpretation and management may have an effect. Increasing women's access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation are other of several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate.
Topics: Breech Presentation; Cesarean Section; Delivery, Obstetric; Female; Heart Rate, Fetal; Humans; Obstetric Labor Complications; Patient Safety; Pregnancy; Risk Assessment; United States; Version, Fetal
PubMed: 24565430
DOI: 10.1016/j.ajog.2014.01.026 -
Journal of Obstetrics and Gynaecology... Aug 2019To discern the risks and benefits of planned vaginal breech birth versus planned Caesarean section and to recommend selection criteria, intrapartum management...
OBJECTIVES
To discern the risks and benefits of planned vaginal breech birth versus planned Caesarean section and to recommend selection criteria, intrapartum management parameters, and delivery techniques for vaginal breech birth.
OPTIONS
Planned vaginal breech birth or planned Caesarean section for women with a singleton breech fetus at term.
OUTCOMES
Perinatal mortality, short- and long-term neonatal/infant morbidity, maternal mortality, and short- and long-term maternal morbidity.
EVIDENCE
Medline was searched up to April, 2018 for randomized trials and cohort studies comparing outcomes after planned vaginal breech birth and planned Caesarean section and for cohort studies comparing vaginal breech birth techniques. Additional articles were identified through bibliography tracing.
VALIDATION
This guideline was peer reviewed by international clinicians with expertise in vaginal breech birth and compared with the 2017 Royal College of Obstetricians and Gynaecologists Green Top Guideline 20b: Management of Breech Presentation. The content and recommendations were drafted and agreed upon by the principal authors. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework.
SPONSORS
The Society of Obstetricians and Gynaecologists of Canada.
SUMMARY STATEMENTS
RECOMMENDATIONS: Labour Selection Criteria Labour Management Delivery Technique Setting and Consent.
Topics: Breech Presentation; Canada; Cesarean Section; Clinical Competence; Contraindications, Procedure; Delivery, Obstetric; Female; Humans; Informed Consent; Patient Care Planning; Patient Selection; Pregnancy
PubMed: 31331608
DOI: 10.1016/j.jogc.2018.12.018 -
Ginekologia Polska 2022To compare a perinatal outcome in breech presentation depending on different modes of vaginal breech delivery (VBD).
OBJECTIVES
To compare a perinatal outcome in breech presentation depending on different modes of vaginal breech delivery (VBD).
MATERIAL AND METHODS
Over the course of 13 years (2005-2018), perinatal outcome of newborns was compared among 98 singleton pregnancies (64 term pregnancies and 34 preterm pregnancies) completed with VBD divided into six groups depending on the mode of delivery used (Bracht, Müller, Thiessen, classical arm release, Mauriceau-Levret-Veit-Smellie (MLVS), and Vermelin´s spontaneous vaginal delivery). Also, maternal demographic parameters were observed.
RESULTS
Of 98 singleton pregnancies, the most frequently used mode was Thiessen (35.71%), followed by MLVS technique (25.51%), Bracht (22.45%), Vermelin (13.27%), classical arm release (2.04%) and Müller (1.02%). Newborns with Apgar score ≤ 7 at 5 min. were transferred to the neonatal intensive care unit (NICU), which included 15.31% of newborns (total 15 newborns: 1 term and 14 preterm newborns). The incidence of episiotomy was 63.27%. Seventy-point five percent of women included in the study were ≤ 35 years of age, and 37.76% were multiparas. Delivery was induced in 7.14% cases.
CONCLUSIONS
Less- traumatizing actions during VBD have less harmful consequences and better perinatal outcome. Lower Apgar score was noted with the aggressiveness of the mode of VBD.
Topics: Adult; Apgar Score; Breech Presentation; Delivery, Obstetric; Episiotomy; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Retrospective Studies
PubMed: 34541651
DOI: 10.5603/GP.a2021.0183 -
The Journal of Maternal-fetal &... Jan 2014Breech presentation represents a common indication for primary cesarean section in women presenting for parturition. This study aims to investigate the presence of new... (Review)
Review
OBJECTIVE
Breech presentation represents a common indication for primary cesarean section in women presenting for parturition. This study aims to investigate the presence of new and old risk factors for breech presentation and to provide a literature review.
METHOD
In this population-based retrospective cohort study, we collected data from 14,433 consecutive singleton deliveries occurred in a 3rd level hospital setting of northeast Italy between January 2001 and July 2009. Related risk factors and trends in breech presentation prevalence were also considered.
RESULTS
Mean maternal age was 31.78 years (±5.17) and mean gestational age at delivery 38.67 weeks (±2.54). Breech presentation prevalence in nullipara and pluripara was respectively 5.36% (415/7743) and 3.53% (236/6689; p<0.05), and was significantly lower among Sub-Saharan-African women 2.62% (14/535) versus 4.51% (651/14432; p<0.05). Also advanced maternal age, early gestational age at delivery, neonatal female gender and low weight at delivery resulted associated with a higher prevalence of breech presentation. By multivariate logistic regression, the breech presentation resulted independently predicted by maternal age, ethnicity, parity, gestational age and neonatal weight MoMs at delivery, and neonatal gender.
CONCLUSIONS
Advanced maternal age, early gestational age, low neonatal weight MoMs at delivery and female gender resulted to be risk factors for fetal breech presentation at delivery, while multiparity and Sub-Saharan-African ethnicity resulted to be protective.
Topics: Adult; Africa South of the Sahara; Birth Weight; Breech Presentation; Cohort Studies; Ethnicity; Female; Gestational Age; Humans; Italy; Male; Maternal Age; Parity; Pregnancy; Retrospective Studies; Risk Factors; Sex Factors
PubMed: 23688372
DOI: 10.3109/14767058.2013.806891 -
BJOG : An International Journal of... Sep 2022To investigate if a hospital-initiated home-based rebozo intervention performed by the pregnant woman and her partner before external cephalic version (ECV) would... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate if a hospital-initiated home-based rebozo intervention performed by the pregnant woman and her partner before external cephalic version (ECV) would increase the rate of cephalic presentations at birth.
DESIGN
A multicentre randomised controlled trial.
SETTING
Three university hospitals in Copenhagen, Denmark.
POPULATION
Pregnant women with a breech or transverse presentation at 35 weeks or more of gestation eligible for ECV.
METHODS
We compared rebozo before ECV with ECV alone. The randomisation was computer-generated in blocks and stratified by parity. The woman and her partner were instructed in the technique by a project midwife and performed the technique at home three times daily for 3-5 days before the scheduled ECV. Analyses were by intention-to-treat.
MAIN OUTCOME MEASURE
The number of cephalic presentations at the time of birth. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.
RESULTS
A total of 372 women were randomly assigned (1:1) to either rebozo intervention (n = 187) or control (n = 185). At birth, 95 (51%) in the intervention group versus 112 (62%) in the control group had a fetus in cephalic presentation (OR 0.61; 95% CI 0.40-0.95). No adverse events were observed in relation to the intervention.
CONCLUSIONS
In breech or transverse presentation, home-based rebozo exercise before ECV lowered the overall rate of cephalic presentation at birth.
TWEETABLE ABSTRACT
Home-based rebozo for breech presentation before external version reduces the rate of cephalic presentation at birth.
Topics: Breech Presentation; Delivery, Obstetric; Female; Humans; Infant, Newborn; Parity; Parturition; Pregnancy; Version, Fetal
PubMed: 35114058
DOI: 10.1111/1471-0528.17111 -
Japan Journal of Nursing Science : JJNS Oct 2021We conducted a pilot trial to compare the effects of smoke and smokeless moxibustion with a control as a possible supplement to external cephalic version (ECV) for...
AIMS
We conducted a pilot trial to compare the effects of smoke and smokeless moxibustion with a control as a possible supplement to external cephalic version (ECV) for converting breech to cephalic presentation and increasing adherence to cephalic position, and to assess their effects on the well-being of the mother and child.
METHODS
We used a quasi-experimental design with 3 arms: a smoke moxibustion (SM) (n = 20) and smokeless moxibustion (SLM) (n = 20) groups (20-min acupoint BL67 stimulation once or twice daily for 10-14 days), and a control group (n = 20). The participants had singleton breech presentations between 33 and 35 gestation weeks. The primary outcome was cephalic presentation at the conclusion of intervention. The secondary outcomes were cephalic presentation at birth and effects on mother and child well-being.
RESULTS
At the conclusion of intervention, cephalic presentation was higher in the SLM (60.0%) than the control groups (25.0%), Relative Risk 2.40, 95% Confidence Interval [1.04-5.56]; there was no significant difference for SM. At birth, there were no significant differences in cephalic presentation or well-being.
CONCLUSION
SLM treatment showed an increasing trend towards cephalic presentation at the conclusion of intervention. Although significant differences were not observed at birth possibly due to the small samples and non-randomization, moxibustion was safe, and not associated with perinatal morbidity and mortality. A randomized controlled trial with a larger sample is warranted to ascertain SLM treatment as a possible ECV supplement for converting and increasing adherence to cephalic position.
Topics: Breech Presentation; Child; Female; Humans; Infant, Newborn; Lobeline; Moxibustion; Pilot Projects; Pregnancy; Smoke
PubMed: 33999503
DOI: 10.1111/jjns.12426