2013 Vas et al Randomized Controlled Trial

Vas et al (2013) (13)  is a single three arm trial which deserves mention for its unique, rigorous design. The study looked at both the effectiveness and safety of moxibustion treatment for breech, but also examined whether moxa applied specifically to UB 67 is more effective than moxa applied to an acu-point not typically indicated for correcting fetal malposition. In addition to these two moxibustion groups,  researchers also included a control group that received usual care in the form of monitoring and instruction in “knee-chest postural management”. The dosage and duration of treatment used in the treatment groups was clinically realistic and relevant. The study was judged by Liao et al (8) to have a low risk of all types of bias.

In this trial, 406 women in Spain were randomized into 3 groups. The study group was large enough to determine statistical significance. The intervention groups either performed moxibustion at Urinary Bladder 67 or Spleen 1 (a point on the inner edge of the first toe) which is thought to be inert for purposes of altering a baby’s position. After receiving education from a midwife trained in moxibustion, the two groups performed moxibustion for 20 minutes daily at home for 2 weeks. The third group only had usual care and no moxibustion. 

All participants were between 33-35 weeks. Such a narrow gestational window is helpful for comparison purposes when determining the best time to use moxibustion during pregnancy. 

At term, vertex presentation was as follows: 58% for moxa to UB 67, 43%  for moxa to SP 1 and 45% in the usual care group. In addition, maternal and fetal heart rate were monitored between all three groups and were not found to have significant differences.  There were no major adverse events in either of the moxibustion groups and no differences in neonatal outcomes. This well-designed study is the first to compare outcomes between real and “sham” moxibustion for breech.  The results showed the specific effect of UB 67 in turning breech babies compared with a sham group and a control group, which showed no significant difference in rate of vertex presentation.