Research during Pregnancy and Labour

Acupuncture at NHS Whittington Hospital during pregnancy & labour

In 2006 the Whittington Hospital in North London introduced a very successful pilot scheme offering acupuncture in the ante natal and day labour wards to treat nausea and vomiting, pain and stress and repositioning of the foetus, and during labour itself to help improve contractions, alleviate pain and anxiety, and expedite the birth.

Influence of acupuncture on duration of labor.

Zeisler H, Tempfer C, Mayerhofer K, Barrada M, Husslein P., Department of Obstetrics and Gynecology, University of Vienna, AKH, Austria.
The aim of this case control study was to evaluate the thus far controversially discussed influence of acupuncture (AP) on the duration of labor. Fifty-seven women with AP treatment (group A) were included in our study after spontaneous vaginal full-term delivery. The control group included 63 women (group B). Median duration of the first stage of labor was 196 min in group A and 321 min in group B (Wilcoxon 2-sample test, p less than 0.0001). Median duration of the second stage of labor was 57 min in group A and 57 min in group B (Wilcoxon 2-sample test, p = 0.82). Thirty women had a premature rupture of the membranes (PROM), in group A 66.7% and in group B 33.3% (chi2 test, p = 0.02). Women without AP (group B) received significantly more often oxytocin during the first stage of labor compared with group A women (85 and 15%, respectively, chi2 test, p = 0.01) as well as during the second stage of labor (72 and 28%, respectively, chi2 test, p = 0.03). Our study suggests that AP treatment is a recommendable form of childbirth preparation due to its positive effect on the duration of labor, namely by shortening the first stage of labor.

Acupuncture for Cervical Maturation

Tremeau ML; Fontanie-Ravier P; Teurnier F; Demouzon J. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction, 1992, 21(4):375-80.
Abstract:
Protocol was carried out on 98 patients who were divided into three groups selected as (one control group, two ‘placebo’ group, and three treated with acupuncture).

This protocol showed that it was possible to improve cervical maturation if acupuncture sessions were carried out at the beginning of the 9th month. The Bishop scores in the three groups after 10 days interval showed that there was a significant progression of 2.61 points in the group treated with acupuncture as against only 0.89 and 1.08 in the placebo and control groups.

Acupuncture for cervical ripening and induction of labor at term–a randomized controlled trial.

Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P., Department of Obstetrics and Gynecology, University of Vienna, Austria.
OBJECTIVE: The aim of this study was to evaluate whether acupuncture at term can influence cervical ripening, induce labor and thus reduce the need for postdates induction. METHODS: On the estimated date of confinement (EDC) women were prospectively randomized to an acupuncture group (AG) or a control group (CG). Data of 45 women were evaluated (AG, n = 25; CG, n = 20). Inclusion criteria were as follows: confirmed EDC, uncomplicated course of pregnancy, singleton pregnancy in cephalic presentation. Exclusion criteria were as follows: cervical dilation > 3 cm, active labor, premature rupture of membranes, previous cesarean section, pathologies in mother or fetus. Women were examined at 2-day intervals. The cervical length was measured with vaginal ultrasonography, cervical mucus was obtained for a fetal Fibronectin test and the cervical status was assessed according to the Bishop score. In the AG, the points Hegu (Large Intestine 4) and Sanyinjiao (Spleen 6) were pierced on both sides every second day. If women were not delivered 10 days after EDC, labor was induced by administering vaginal prostaglandin tablets. RESULTS: The cervical length in the AG was shorter than that in the CG on day 6 and day 8 after EDC (P = 0.04 for both). In the AG the time period from the first positive Fibronectin test to delivery was 2.3 days, while that in the CG was 4.2 days (P = 0.08). The time period from EDC to delivery was on average 5.0 days in the AG and 7.9 days in the CG (P = 0.03). Labor was induced in 20% of women in the AG (n = 5) and in 35% in the CG (n = 7) (P = 0.3). Overall duration of labor, and first and second stage of labor were not different in the two groups. In 56% of women who underwent acupuncture (n = 14) and in 65% of controls (n = 13), Oxytocin was used to augment labor. (P = 0.54). CONCLUSION: Acupuncture at points LI4 and SP 6 supports cervical ripening at term and can shorten the time interval between the EDC and the actual time of delivery.

Moxibustion for Turning Breech Babies
Moxibustion for correction of breech presentation: a randomized controlled trial.

Cardini F, Weixin H JAMA 1998 Nov 11;280(18):1580-4
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.
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.

Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study.

Neri I, Airola G, Contu G, Allais G, Facchinetti F, Benedetto C., Department of Obstetrics and Gynecology, University of Modena-Reggio Emilia, Modena, Italy.

OBJECTIVE: In many Western countries breech presentation is an indication for elective Cesarean section. In order to correct fetal presentation, the stimulation of the acupuncture point BL67 by moxibustion, acupuncture or both has been proposed. Since no studies had previously been carried out on Western populations, pregnant Italian women at 33-35 weeks gestational age carrying a fetus in breech presentation were enrolled in a randomized, controlled trial involving an active BL67 point stimulation and an observation group. METHODS: A total of 240 women at 33-35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. Bilateral acupuncture plus moxibustion was applied at the BL67 acupuncture point (Zhiyin). The primary outcome of the study was fetal presentation at delivery. RESULTS: Fourteen cases dropped out. The final analysis was thus made on 226 cases, 114 randomized to observation and 112 to acupuncture plus moxibustion. At delivery, the proportion of cephalic version was lower in the observation group (36.7%) than in the active-treatment group (53.6 %) (p = 0.01). Hence, the proportion of Cesarean sections indicated for breech presentation was significantly lower in the treatment group than in the observation group (52.3% vs. 66.7%, p = 0.03). CONCLUSIONS: Acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth

Non-stress test changes during acupuncture plus moxibustion on BL67 point in breech presentation.

Neri I, Fazzio M, Menghini S, Volpe A, Facchinetti F., Clinica Ostetrica, Universita di Roma-Tor Vergata, Rome, Italy.

OBJECTIVES: We assessed fetal heart variability and activity using a computerized non-stress test (NST) during acupuncture plus moxibustion on the BL67 point. For comparison, the same changes were assessed during placebo acupuncture (minimal acupuncture) in the same subjects. METHODS: Twelve pregnant women in the 33rd week of gestation, carrying singletons in the breech presentation were enrolled in the study. In a single-blind design, each woman received a first session of minimal acupuncture followed 1-2 days later by true acupuncture. During the sessions, women were monitored using computerized non-stress testing starting 20 minutes before the stimuli and continuing for 20 minutes after treatment. RESULTS: During true acupuncture a significant reduction in fetal baseline heart rate, and more accelerations and movement were observed. During minimal acupuncture, there were no significant changes in these variables. No signs of fetal distress or changes in short- or long-term variability were noted, and there were no uterine contractions. CONCLUSION: In our study population, acute application of acupuncture plus moxibustion did not cause fetal distress as assessed by either fetal heart rate decelerations or changes in either short- or long-term variability. Considering that the modifications in fetal movement and heart rate occurred in true but not during minimal acupuncture, we could consider that such changes are related to the effect of the acupuncture stimulation. The mechanisms leading to the cephalic version remain to be clearly established.

Moxibustion at Bl-67 for the correction of breech presentation

Research into moxibustion at Bl-67 for the correction of breech presentation after the thirty-third week of gestation, has found a success rate of 84.6 percent. Being a cheap, safe, simple, non-invasive, and painless technique, there is an ongoing trend toward offering this treatment as an option in breech baby cases. (Ewies & Olah, 2002).

Research has shown that moxibustion for one to two weeks at Bl-67 increased fetal activity during the treatment period and cephalic presentation after the treatment period, at delivery. (Cardini & Weixin, 1998).

Acupuncture for Morning Sickness
Manual acupuncture reduces hyperemesis gravidarum

A placebo-controlled, randomized, single-blind, crossover study.
Carlsson CP, Axemo P, Bodin A, Carstensen H, Ehrenroth B, Madegard-Lind I, Navander C.
Physical Medicine Unit, Department of Rehabilitation, University Hospital, Lund, Sweden.

Hyperemesis gravidarum, severe vomiting, develops in about 1-2% of all pregnancies. Acupuncture on the point PC6 above the wrist on the palmar side has been found to prevent some types of nausea and vomiting. The purpose of the present study was to see if acupuncture, in addition to standard treatment, could hasten the improvement of hyperemesis gravidarum. Thirty-three women with hyperemesis were evaluated in a randomized, single-blind, crossover comparison of two methods of acupuncture, active (deep) PC6 acupuncture or placebo (superficial) acupuncture. The women estimated their degree of nausea on a visual analogue scale (VAS).
The daily number of emesis episodes were documented. Crossover analyses showed that there was a significantly faster reduction of nausea VAS and more women who stopped vomiting after active acupuncture than after placebo acupuncture. This study suggests that active PC6 acupuncture, in combination with standard treatment, could make women with hyperemesis gravidarum better faster than placebo acupuncture.

Success of Acupuncture and Acupressure of the Pc 6 Acupoint in the Treatment of Hyperemesis Gravidarum

D. Habek, A. Barbir, J. . Habek, D. Jan uliak, M. Bobi -Vukovi, Research in Complementary and Classical Natural Medicine 2004;11:20-23

Objective: The aim of this study was to evaluate the antiemetic effect of acupuncture (AP) and acupressure (APr) of the Pc 6 acupoint in pregnant women with hyperemesis gravidarum (HG). Methods: A prospective, placebo-controlled trial included 36 pregnant women with HG. Two methods of acupuncture were used: bilateral manual AP of the Pc 6 (Neiguan) acupoint (group 1, n = 10) and bilateral APr of the Pc 6 acupoint (group 2, n = 11); furthermore, superficial intracutaneous placebo AP (group 3, n = 8) and placebo APr (group 4, n = 7) was carried out. Results: Anxiodepressive symptoms occurred in 9 pregnant women with HG from group 1, 8 women from group 2, 7 women from group 3, and 5 women from group 4 (p less than 0.001). The average gestation age at the occurrence of HG symptoms and the beginning of treatment was 7 weeks in group 1 and 8 weeks in groups 2, 3, and 4. Four women from group 1 and 7 women from groups 2, 3, an 4 needed intravenous compensation of liquid and electrolytes. The antiemetic metoclopramide was given intravenously to 1 woman from group 1, 2 women from group 2, 6 women from group 3, and 4 women from group 4. Promethazine was given to 1 woman from group 2, 1 woman from group 3, and to 3 women from group 4. The efficiency of the HG treatment with AP of the point Pc 6 was 90%, with APr of the Pc 6 63.6%, with placebo AP 12.5%, and with placebo APr 0%. Conclusion: Acupuncture (p less than 0.0001) and acupressure (p less than 0.1) are effective, nonpharmacologic methods for the treatment of HG.

Acupuncture for Pain During Pregnancy
Acupuncture for low back pain in pregnancy–a prospective, quasi-randomised, controlled study.

Acupunct Med. 2004 Jun;22(2):60-7., Guerreiro da Silva JB, Nakamura MU, Cordeiro JA, Kulay L Jr.
This study was undertaken to investigate the effects of acupuncture in low back and pelvic pain during pregnancy under real life conditions, as compared with patients undergoing conventional treatment alone. A total of 61 conventionally treated pregnant women were allocated randomly into two groups to be treated or not by acupuncture. Twenty-seven patients formed the study group and 34 the control group. They reported the severity of pain using a Numerical Rating Scale from 0 to 10, and their capacity to perform general activities, to work, and to walk. We also assessed the use of analgesic drugs. Women were followed up for eight weeks and interviewed five times, at two-week intervals. All women completed the study. In the study group the average pain during the study period showed a larger reduction (4.8 points) than the control group (-0.3 points) (P < 0.0001). Average pain scores decreased by at least 50% over time in 21 (78%) patients in the acupuncture group and in five (15%) patients in the control group (P < 0.0001). Maximum pain and pain at the moment of interview were also less in the acupuncture group compared with the control group. The capacity to perform general activities, to work and to walk was improved significantly more in the study group than in the control group (P < 0.05). The use of paracetamol was lower in the acupuncture group (P < 0.01). These results indicate that acupuncture seems to alleviate low back and pelvic pain during pregnancy, as well as to increase the capacity for some physical activities and to diminish the need for drugs, which is a great advantage during this period.

Pelvic Pain Relief for Pregnant Women

British Medical Journal, published online March 17, 2005

A new study shows acupuncture and strengthening exercises may help relieve pelvic girdle pain experienced by pregnant women.

The pelvic girdle is a complex of bones that connects the trunk and legs. Pain in the pelvic girdle is very common among pregnant women. The study authors explain this pain inhibits the ability to stand, walk and sit, but there is no cure. Standard treatment consists of a pelvic belt and a home exercise regimen. However, the effectiveness of these options is questionable. So, researchers in Sweden set out to investigate whether acupuncture or strengthening exercises could help manage the pain.

They divided 386 women into three groups. One received standard treatment, another received standard treatment plus acupuncture, and the third underwent standard treatment plus stabilizing exercise that improved mobility and strength. These women recorded their pain levels every morning and evening and were examined at the end of the treatment period.

Both the acupuncture group and the stabilizing-exercise group had less pain than the standard treatment group in the morning and evening. The acupuncture group showed the greatest reduction of pelvic girdle pain. The study authors conclude acupuncture or these specific exercises prove beneficial in addition to standard treatment for pelvic girdle pain.

Acupuncture with Assisted Reproduction Therapy

Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy.

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K., Department of Reproductive Medicine, Christian-Lauritzen-Institut, Ulm, Germany.
OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture. DESIGN: Prospective randomized study. SETTING: Fertility center. PATIENT(S): After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80). INTERVENTION(S): Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy. MAIN OUTCOME MEASURE(S): Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer. RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group. CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after ART.