RESUMEN
OBJECTIVE: This study aimed to evaluate the bibliographic references available on the contribution of acupuncture as a strategy to avoid labor induction and the methodology used; and explore the characteristics of the population and the results of the intervention in order to direct the design of future studies. DATA SOURCE: A systematic search for publications between January 2000 and September 2023 of the CENTRAL, PubMed, CINAHL, SCOPUS, ClinicalTrials.gov, and EUDRACT databases was performed. STUDY ELIGIBILITY CRITERIA: We included randomized clinical trials of pregnant women who underwent acupuncture before labor induction with a filiform needle or acupressure, including at least 1 of the following outcomes: spontaneous labor rate, time from procedure to delivery, and cesarean delivery rate. Articles published in English or German language were included. METHODS: Whenever possible, a meta-analysis using RevMan software was performed using a random effects model with the I2 statistic because important heterogeneity in the different acupuncture treatments was expected. When enough data were available, the effect of the participants' characteristics on the results of the interventions were explored using the following subgroups: 1-Age (≥35 vs <35 years), and 2- body mass index (≥30 vs <30 kg/m2). When a meta-analysis was not possible, a narrative synthesis of the results was performed. The quality of the evidence was assessed using GRADE. RESULTS: Seventeen studies including 3262 women fulfilled our inclusion criteria. The meta-analysis showed no statistically significant differences between groups for outcomes (relative risk, 1.00; 95% confidence interval, 0.91-1.10; I2, 11%) comparing acupuncture vs sham acupuncture. However, there was a statistically significant increase in the spontaneous onset of labor rate favoring acupuncture vs no acupuncture (relative risk, 1.12; 95% confidence interval, 1.03-1.23; I2, 25%). Regarding the age analysis, no differences between groups were observed in the spontaneous labor rate and cesarean delivery rate for acupuncture vs sham and acupuncture vs no acupuncture comparisons (difference between groups, P>.05). CONCLUSION: This study suggests that acupuncture may be beneficial in reducing the rate of induction of labor; however, well-designed randomized controlled trials are necessary. Maternal age ≥35 years and a high body mass index were underrepresented, and the findings may not be representative of the current population in our context.
Asunto(s)
Terapia por Acupuntura , Trabajo de Parto , Embarazo , Femenino , Humanos , Adulto , Terapia por Acupuntura/métodos , Cesárea , Trabajo de Parto Inducido/métodos , Índice de Masa Corporal , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJETIVO: Evaluar la eficacia de la moxibustión, combinada con la posición genupectoral, para versionar fetos en presentaciones no cefálicas a cefálica, durante el tercer trimestre de gestación. Como objetivos secundarios se planteó evaluar la seguridad de la técnica de moxibustión e identificar el tipo de parto, las semanas de gestación (SG) y el peso del recién nacido. MATERIAL Y MÉTODOS: Ensayo clínico aleatorizado, controlado y multicéntrico, realizado en consultas de 9 centros de atención a la salud sexual y reproductiva de la comarca del Baix Llobregat (Barcelona). La selección de gestantes se hizo tras la ecografía del tercer trimestre. Si se observaba una presentación no cefálica, se invitaba a las gestantes a participar. Tras firmar el consentimiento, se procedía a la asignación aleatoria a un grupo de intervención (GI) o a un grupo control (GC). El GI recibió 1 semana de tratamiento con moxibustión en el punto BL67 y posición genupectoral. El GC recibió tratamiento con moxibustión en un punto neutro y posición genupectoral. Las participantes recibieron las explicaciones necesarias para la aplicación de la técnica 2 veces al día durante 1 semana. RESULTADOS: Participaron 88 gestantes entre las 32 y 36 SG. Hubo 47 gestantes en el GI y 41 en el GC, con características similares al inicio del estudio. El número de sesiones aplicadas fue similar en ambos grupos, sin complicaciones. El 44,7% de los partos del GI fueron en presentación cefálica, frente al 43,9% del GC (p= 0,6). El número de partos vaginales en el GI fue de 18 (38,3%), frente a 13 (31,7%) en el GC (p= 0,3). No se observaron diferencias en las SG en el momento del parto ni en el peso de los recién nacidos. CONCLUSIONES: El uso de la moxibustión aplicada durante 7 días en el punto BL67 junto con la posición genupectoral entre las 32 y 36 SG no demostró en este estudio un aumento de las versiones de fetos en posiciones anómalas a cefálica. La técnica no presentó complicaciones
AIM: To evaluate moxibustion efficacy, combined with knee-chest position, for foetus version from no cephalic presentation to cephalic presentation during the 3rd trimester of gestation. To evaluate the security of the moxibustion technique and to identify type of delivery, weeks of gestation and the weight of the newborn. Subjects, material and methods: Multicenter, randomized, controlled trial conducted in 9 primary care centres focused on sexual and reproductive health of the Baix Llobregat (Barcelona) region. Selection was done after the 3rd trimester ultrasound scan. When a non-cephalic presentation was found, women were asked to join the study. After signing the informed consent, random allocation took place and they were divided into intervention group (IG) and control group (CG). IG received a one week treatment with moxibustion at point BL67 combined with knee-chest position. CG received moxibustion treatment at a neutral point combined with knee-chest position too. For both groups they were given the necessary explanations for a correct application twice a day during a week. RESULTS: A total 88 pregnant women between 32-36 weeks of gestation were studied, 47 pregnant mothers enrolled in IG and 41 in CG, with similar characteristics at the beginning of the study. Number of performed sessions was similar for both groups and without complications
