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Research on Acupuncture and Pregnancy

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Acupuncture for labour (labor)

A recent research suggests that acupuncture may help control pain during childbirth. Previous studies have found that acupuncture may be helpful in treating low back pain, acute dental pain and recurrent headaches. Acupuncture has also been used to treat morning sickness and to induce labour (labor).

To evaluate, researchers from the Universities of Exeter and Plymouth, UK conducted a computerized literature search of several databases. They identified three trials that fitted their quality standards. In the first trial, 106 women who received acupuncture along with conventional medication were compared with 92 women who were given only conventional care. It was found that the acupuncture group was less likely to request for pain medications than those who did not receive acupuncture. Almost all women treated with acupuncture said they would use the complementary treatment again for labour (labor) pain.

The second trial involved 90 women who were randomly assigned to a group that received acupuncture or a group that received conventional care. Both groups were also given the requested pain medication or non-pharmacologic pain management techniques such as a bath or shower. It was found that women in the acupuncture group requested less of one pain medication, but similar levels of other pain medications than those in the comparison group. The acupuncture group also reported a higher level of relaxation than their peers and was less likely to request non-pharmacologic pain treatment.

In the third trial, 106 women received acupuncture and 102 women received placebo acupuncture, in which superficial needles were applied to non-acupuncture points. None of the women knew whether they received acupuncture or the sham treatment. The acupuncture group reported less pain up to two hours after acupuncture and two hours after giving birth than those who received the sham treatment. The women who received acupuncture requested less pain medication than their counterparts.

Overall, the data suggest that acupuncture can be another option for pregnant women for labour (labor) pain management if future trials support acupuncture's effect.

Acupuncture during labor can reduce the use of meperidine: a controlled clinical study

Nesheim BI, Kinge R, Berg B, Alfredsson B, Allgot E, Hove G, Johnsen W, Jorsett I, Skei S, Solberg S., Department of Obstetrics and Gynecology, Ulleval University Hospital, Oslo, Norway.
OBJECTIVE: To evaluate the effectiveness of acupuncture as an analgesic during labor. DESIGN: A randomized, unblinded, controlled study. SETTING: A labor ward in a University Hospital. PATIENTS: Parturients at term. INTERVENTIONS: One group received acupuncture (N = 106); another did not (N = 92). A second control group (N = 92), drawn from the labor ward protocol, consisted of patients who met the eligibility criteria for the study and were matched to the "no acupuncture" group by parity, but who had not been offered the opportunity to take part. Outcome measure "effectiveness of acupuncture" was measured by the requirement for use of meperidine. RESULTS: Meperidine was given to 11% of the acupuncture group, 37% of the no acupuncture group (P

Acupuncture in the management of pain in labor

Skilnand E, Fossen D, Heiberg E., Department of Obstetrics and Gynecology, County Hospital of Oestfold, Fredrikstad, Norway.
BACKGROUND: To assess if acupuncture could be a reasonable option for pain relief in labor and to look at possible effects of acupuncture on the progress of labor. METHODS: In a controlled, single blind study, 210 healthy patients in spontaneous, active labor at term were randomly assigned to receive either real acupuncture or false acupuncture. Visual analog scale assessments were used to evaluate subjective effect on pain. The objective parameter of outcome was the need for analgesic medication in each group. RESULTS: There were significantly lower mean pain scores and significantly less need for pharmacological analgesia in the study group compared with the control group. The women given real acupuncture spent less time in active labor and needed less augmentation than the control group. CONCLUSION: The results indicate that acupuncture reduces the experience of pain in labor. A secondary outcome of acupuncture was a shorter delivery time, which mainly, if not exclusively, can be explained by the reduced need for epidural analgesia. Acupuncture may be useful for patients who wish a nonpharmacological analgesia without side-effects. For others it could be the analgesic method of choice, with pharmacological analgesics as supplements.

Acupuncture treatment during labour--a randomised controlled trial

Ramnero A, Hanson U, Kihlgren M., Department of Obstetrics and Gynaecology, Orebro University Hospital, Sweden.
OBJECTIVE: To investigate acupuncture treatment during labour with regard to pain intensity, degree of relaxation and outcome of the delivery. DESIGN: Randomised controlled trial. SETTING: Delivery ward at a tertiary care centre hospital in Sweden. POPULATION: Ninety patients who delivered during the period April 12, 1999 and June 4, 2000. METHODS: Forty-six patients were randomised to receive acupuncture treatment during labour as a compliment, or an alternative, to conventional analgesia. MAIN OUTCOME MEASURES: Assessments of pain intensity and degree of relaxation during labour, together with evaluation of delivery outcome. RESULTS: Acupuncture treatment during labour significantly reduced the need of epidural analgesia (12% vs 22%, relative risk [RR] 0.52, 95% confidence interval [CI] 0.30 to 0.92). patients who received acupuncture assessed a significantly better degree of relaxation compared with the control group (mean difference -0.93, 95% CI -1.66 to -0.20). No negative effects of acupuncture given during labour were found in relation to delivery outcome. CONCLUSIONS: The results suggest that acupuncture could be a good alternative or complement to those patients who seek an alternative to pharmacological analgesia in childbirth. Further trials with a larger number of patients are required to clarify if the main effect of acupuncture during labour is analgesic or relaxing.

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

by Tremeau ML; Fontanie-Ravier P; Teurnier F; Demouzon J. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction, 1992, 21(4):375-80.
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.

Acupuncture for Breech Presentation

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.
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 (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 (Plessthan.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 (Plessthan.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.

Acupuncture conversion of fetal breech presentation

Habek D, Cerkez Habek J, Jagust M.Clinical Department of Obstetrics and Gynecology, Clinical Hospital Osijek, Osijek, Croatia.
AIM: The aim of this study was to assess the value of acupuncture (AP) in the conversion of fetal breech presentation into vertex presentation.
PATIENTS AND METHODS: A randomized prospective controlled clinical study included 67 pregnant women with fetal breech presentation: 34 women with singleton pregnancies treated with manual AP (urinary bladder 67, Zhiyin) and a control group which included 33 women with singleton pregnancies without AP treatment. The AP treatment lasted 30 min a day, and was conducted during and after 34 weeks of pregnancy with simultaneous cardiotocography. RESULTS: The success rate of the AP correction of fetal breech presentation is 76.4% (26 women), and spontaneous conversion without AP in vertex presentation is observed in 15 women (45.4%; p0.001).
CONCLUSIONS: We believe that AP correction of fetal malpresentation is a relatively simple, efficacious and inexpensive method associated with a lower percentage of operatively completed deliveries, which definitely reflects in improved parameters of vital and perinatal statistics.

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.

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

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.

Other Pregnancy Research

Influence of acupuncture on Doppler ultrasound in pregnant women

Zeisler H, Eppel W, Husslein P, Bernaschek G, Deutinger J., Department of Obstetrics and Gynecology, University of Vienna, General Hospital Vienna, Austria.
OBJECTIVE: To evaluate the influence of acupuncture on the blood flow in the umbilical artery (UA), fetal aorta and uterine artery and on the fetal heart rate using two different acupuncture points (SP-6 (Sanyinjiao) and LI-4 (Hegu)). METHODS: In group A (n = 50), measurements (Doppler ultrasound and fetal heart rate) were performed at term after an uneventful pregnancy (#1) followed by acupuncture treatment using the acupuncture-point SP-6 bilaterally. The treatment time lasted 15 min after which the next measurement (#2) was carried out. The needles were then inserted into the LI-4 acupuncture point for a further 15 min. A third measurement at the end of acupuncture treatment (#3) completed the session. In group B (n = 25), measurements were made before (#1) and after (#4) acupuncture at LI-4 acupuncture points only. RESULTS: In group A, the mean systolic/diastolic (S/D) ratios of UA #1, UA #2 and UA #3 were 2.45, 2.38 and 2.22, respectively (P = 0.0012). The difference in mean S/D ratios between UA #1 and UA #3 as well as that between UA #2 and UA#3 were statistically significant (P = 0.0002 and P = 0.008, respectively). There was no difference between the mean S/D ratios of the uterine artery and between the mean resistance indices of the fetal aorta. In group B, the only significant difference between measurements following acupuncture treatment was in fetal heart rate (139 vs. 143 bpm, P = 0.02). CONCLUSION: Our study indicates a positive influence of acupuncture treatment on umbilical artery waveforms when using a combination of SP-6 (Sanyinjiao) and LI-4 (Hegu) acupuncture points. Acupuncture performed at these sites either individually or in combination does not seem to affect blood flow in the fetal aorta or uterine artery.

Pre-Term Labour: The effect of acupuncture on uterine contraction induced by oxytocin

Pak SC, Na CS, Kim JS, Chae WS, Kamiya S, Wakatsuki D, Morinaka Y, Wilson L Jr., Department of Acupuncture and Anatomy, Dongshin University, Naju, South Korea.
Preterm labor (PTL) is one of the main causes of fetal mortality and morbidity in obstetrical medicine. Current methods of treatment are not very effective and often have significant side effects. For this reason new methods of preventing PTL are currently being sought. In Western medicine the newest development is oxytocin antagonists. In Oriental medicine acupuncture and moxibustion are being utilized for the purpose of stopping PTL. The goals of this study were to determine if acupuncture in pregnant rats can suppress oxytocin induced uterine contractions and to compare these results with those inhibited by an oxytocin antagonist. Uterine contractions were induced by continuous infusion of exogenous oxytocin. The first fetus in one uterine horn near the ovarian end was removed and distilled water-filled catheter was inserted into that vacated amniotic sac to measure uterine contractions as intrauterine pressure changes. Two acupuncture points of Ho-Ku (LI-4) and San-Yin-Chiao (Sp-6) were selected for acupuncture and Kuan-Yuan (Co-4) was used for moxibustion. The oxytocin-induced uterine contractions were significantly suppressed by acupuncture on the LI-4 (p 0.05) tocolytic effect. The administration of oxytocin antagonist eliminated all the uterine contractions induced by oxytocin. The application of acupuncture to re-stimulate the activity that was suppressed by the oxytocin antagonist did not produce any positive results. However, prostaglandins did cause the uterus to contract. In conclusion, acupuncture on LI-4 was found to suppress uterine contractions induced by oxytocin in the pregnant rat. If acupuncture is similarly effective in counteracting the effects of oxytocin in women, then this may an alternative medical treatment for women in preterm labor.