title: Acupuncture version of breech presentation: a randomized sham-controlled single-blinded trial.
abstract: BACKGROUND
  Several studies have investigated the efficacy of moxibustion with or without acupuncture for fetal version, but the results are discordant. Meta-analyses pointed out the need for robust, methodologically sound, randomized controlled trials.
  
  
  OBJECTIVE
  The objective of this study was to assess the effectiveness of acupuncture with fire needling on acupoint BL67 for version of breech presentation.
  
  
  METHODS
  This was a randomized, sham-controlled, single-blinded trial, which took place in Strasbourg teaching maternity hospital, France. A total of 259 patients between 32 and 34 weeks of gestation have been randomized and analyzed. Patients were randomized to either acupuncture with fire needling or sham group, and were analyzed in their initial allocation group. Statistical analysis was conducted using Bayesian methods, in univariate analysis and in multivariate analysis after adjustment on parity.
  
  
  RESULTS
  The primary outcome was the rate of cephalic presentations at ultrasound examination performed between 35 and 36 weeks of gestation. A total of 49 (37.7%) fetuses were in cephalic presentation in the acupuncture group, versus 37 (28.7%) in the sham group: RR 1.34 [0.93-1.89], Pr RR>1=94.3%. After adjustment on parity, the acupuncture did not increase the rate of fetal cephalic version: OR 1.47 [0.84-2.42], Pr OR>1=90.3%.
  
  
  CONCLUSIONS
  Our study suggests that acupuncture with fire needling on acupoint BL67 does not promote fetal cephalic version. Further studies might investigate effectiveness of other protocols of acupuncture. Randomization should be stratified for nulliparous and parous patients.
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France; UMR-S 1121 Inserm, "Biomatériaux et Bioingénierie", Strasbourg, France. Electronic address: nicolas.sananes@chru-strasbourg.fr.
authors: Nicolas
authors: N
authors: Sananes
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France.
authors: Georges E
authors: GE
authors: Roth
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France.
authors: Germain A
authors: GA
authors: Aissi
authors: Department of Public Health, Strasbourg University Teaching Hospital, France.
authors: Nicolas
authors: N
authors: Meyer
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France.
authors: Annick
authors: A
authors: Bigler
authors: Maternité de l'Hôtel Dieu, Saint-Martin, France.
authors: Jean-Michel
authors: JM
authors: Bouschbacher
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France.
authors: Christine
authors: C
authors: Helmlinger
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France.
authors: Brigitte
authors: B
authors: Viville
authors: Department of Obstetrics and Gynecology, Centre Hospitalier Sainte-Catherine, Saverne, Strasbourg, France.
authors: Mélanie
authors: M
authors: Guilpain
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France.
authors: Adrien
authors: A
authors: Gaudineau
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France.
authors: Chérif Y
authors: CY
authors: Akladios
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France.
authors: Israël
authors: I
authors: Nisand
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France.
authors: Bruno
authors: B
authors: Langer
authors: Maternal Fetal Medicine Department, Hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; UMR 1027 Inserm, Université Paul Sabatier Toulouse III, Toulouse, France.
authors: Christophe
authors: C
authors: Vayssiere
authors: Department of Obstetrics and Gynecology, Strasbourg Teaching Hospital, France.
authors: Romain
authors: R
authors: Favre
mesh_terms: D015670:Acupuncture Therapy; D000328:Adult; D001946:Breech Presentation / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D011247:Pregnancy; D016037:Single-Blind Method; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014710:Version, Fetal / Q000379:methods*
keywords: Acupuncture; Breech presentation; Fire needling; Version