[Influence of antenatal acupuncture on cardiotocographic parameters and maternal circulation - a prospective study].
BACKGROUND
Acupuncture as a non-evidence-based therapy modality is widely used in obstetrics prior to and during delivery. Thus far, only few studies investigated the impact of acupuncture on obstetric surveillance parameters like cardiotocography. The aim of this study was to control the effect of clearly-defined acupuncture on CTG parameters.


METHODS
61 low-risk singleton pregnancies between 30 + 0 and 39 + 6 weeks of gestation were prospectively treated with acupuncture at GV 20 and ST 36 bilaterally for the purpose of maternal relaxation by the same investigator under CTG control. Before (Phase 1), during (Phase 2) and after (Phase 3) treatment the cardiotocogram was recorded. Controlled parameters of outcome were the Fisher score, uterine activity (Phase 1, 2, 3) and maternal blood pressure and pulse before (Phase 1) and after (Phase 2) administration of acupuncture. In a matched control group, 60 pregnant women were monitored by an identical scheme without application of acupuncture and the same outcome parameters were recorded.


RESULTS
: The CTG analysis revealed a statistically significant increase of the Fisher score as well as uterine activity which tended to trace back to pretherapeutic initial values. The systolic maternal blood pressure was found to show a statistically significant decrease while diastolic blood pressure and pulse frequency remained unchanged. In the control group, the comparison of phase 1 vs. phase 2 showed a statistically significant increase of the Fischer score and uterine activity. During phase 3 the Fischer score further increased in contrast to a statistically significant slight reduction of uterine activity. Maternal systolic blood pressure measured at the end of phase 2 was found to be statistically reduced while diastolic blood pressure and pulse remained unchanged. The extent of the systolic blood pressure reduction was markedly higher in the acupuncture group as compared to the control group.


CONCLUSIONS
Antenatal acupuncture as a reflex therapy for the purpose of maternal relaxation seems to exert an influence on short-term alterations of the fetal activity (transient increase in terms of Fischer score) with reversibly increased uterine activity as detected by cardiotocography. Also, a slight reduction of the maternal blood pressure seems to be effected. The phenomena recorded in the control group (relaxation without supportive acupuncture treatment) revealed to be partially concordant (reversibly increased uterine activity, mild maternal reduction of systolic blood pressure) and partially discordant (persisting increase of Fischer score) as compared with the acupuncture group. Acupuncture seems not only to have a psychological, but also a short-term somatic effect with direct influence on maternal and fetal circulation parameters. Other established surveillance parameters and different points of acupuncture should be studied to further elucidate the underlying interaction as well as the duration of this effect.
Frauenklinik der Med. Hochschule Hannover im Oststadtkrankenhaus. Abteilung I für Geburtshilfe, Pränatalmedizin und allg. Gynäkologie, Hannover. alexander.scharf.oststadt@kinikum-hannover.de
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Scharf
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Staboulidou
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Günter
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Wüstemann
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Sohn
D026881:Acupuncture; D015669:Acupuncture Points; D000328:Adult; D001143:Arousal / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D015148:Cardiotocography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008432:Mathematical Computing; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care; D011674:Pulse; D012064:Relaxation Therapy; D012815:Signal Processing, Computer-Assisted; D014590:Uterine Contraction / Q000502:physiology*