Abstract
Objectives
Pharmacological labor induction is obtained through prostaglandins application and/or oxytocin infusion; however, the use seems to be related to fetal and maternal side effects. Traditional Chinese Medicine advocates the use of acupuncture to soften the cervix and induce uterine contractions. at which presented for The primary outcome was the rate of women admitted for labour induction in case of prolonged pregnancy at 41 + 5 weeks, and the secondary outcome was the rate of induction planning for other indications.
Methods
After obtaining informed consent, 375 undelivered women after 40 + 2 gestational age were enrolled for the study: 112 women received acupuncture and 263, routine care. Acupuncture was applied every odd day starting from 40 + 2 weeks up to 41 + 4 weeks. Women allocated to the control group received standard care. At 41 + 5 weeks, a pharmacological induction was planned.
In the acupuncture group, women had acupuncture session every odd day starting from 40 + 2 weeks up to 41 + 4 weeks, and controls received standard care.
Following Traditional Chinese Medicine indications, we stimulated acupoints indicated to enhance uterine activity, ripe the cervix, or relax the muscles and reduce anxiety [3]. Hegu Large Intestine 4 is located in the middle of the first interosseous muscle of the hand, and the needle is inserted to a depth of 1–2 cun. It is claimed to improve uterine contractions. Sanyinjiao Spleen 6 is located 3 cun above the medial malleoli, and the needle is inserted to a depth of 1.5–2.5 cun. It is claimed to promote the ripening of the cervix and to promote uterine contractions. Zhusanli Stomach 36 is located 3 cun above the tip of the medial malleoli on the medial border of the tibia, and the needle is inserted to a depth of 1–2 cun. It is able to improve circulation in the pelvic organs and is employed in several acupuncture formula. Thaichong Liver 3 is located in the foot, in the interosseous muscle between the first and second toe, and the needle is inserted to a depth of 0.2–0.5 cun. It is used in particular to resolve the liver Qi stagnation. Zhiyin Bladder 67 is located on the dorsal (upper) surface of the small toe (the fifth toe, digitus minimus) lateral and proximal to the nail. Jian Jing Gallbladder 21 is located on the shoulder, directly above the nipple, at the midpoint of the line connecting DU 14 and the acromion. Feng Shi Gallbladder 31 is on the midline of the lateral aspect of the thigh, 7 cun above the transverse popliteal crease. When the patient is standing erect with the hands hanging down close to the sides, the point is where the tip of the middle finger touches.
Results
The rate of labor induction significantly differed between acupuncture and observation groups (19.6% vs. 38%; p < 0.01); in particular, women receiving acupuncture showed a lower rate of induction, indicating prolonged pregnancy (5.3% vs. 10.1%; p < 0.01).
As far as the pharmacological device is concerned, no differences were observed with regard to the prostaglandins use, whereas oxytocin infusion rate was lower in the acupuncture group than in the observation group.
Conclusions
The present study suggested that acupuncture applied at term of pregnancy seems to be effective in reducing the rate of labor induction which is performed for prolonged pregnancy at 41 + 5 weeks. Moreover, acupuncture also seems to be able to reduce oxytocin use; such a “saving” effect could play a role in childhood, considering that a recent study underlined the adverse effect of oxytocin on birth outcomes
Autoren: Isabella Neri Lucrezia Pignatti Francesca Fontanesi Fabio Facchinetti
Publiziert in: Journal of Acupuncture and Meridian Studies
Quelle: www.sciencedirect.com