The role of traditional Chinese medicine in cases of abnormal presentations in the third trimester : an evidence-based literature review

Abstract

Background: Abnormal foetal presentation, particularly breech presentation, poses significant risks for both the mother and foetus. Traditional Chinese Medicine (TCM) offers alternative approaches like moxibustion and acupuncture, which may provide non-invasive options to address these presentations. This literature review examines the success rate of foetal cephalic version through the analysis of twelve studies focusing on interventions of moxibustion and acupuncture, separately or in combination, and as a complementary therapy to External Cephalic Version (ECV). Aims and Objectives: The aim of this review is to explore and compare the use of acupuncture and moxibustion used, both in conjunction and separately, in order to increase the chances of normal vaginal delivery in an abnormal foetal presentation during the third trimester by correcting the foetal presentation to cephalic. Additionally, the review also examines the concurrent application of these Chinese medicine treatments with Western medicine's External Cephalic Version, with the aim of delivering improved outcomes for expectant mothers. Moreover, the objective of this dissertation is to carry out a literature review of systematic methodologies for the analysis of research such as randomised controlled trials (RCTs), where the effectiveness of Chinese traditional medicine treatments on abnormal foetal presentation in the third trimester was analysed, comparing this to the western medicine approach. Research questions: • Does the use of Traditional Chinese medicine techniques of moxibustion and acupuncture, in conjunction as well as separately, have an effect on abnormal foetal presentation in the third trimester? And if there is, is there a difference in the outcome when the different use of these techniques is compared? • Do these modalities have an effect on improving the outcomes of an ECV procedure? Method: A literature search was conducted using databases accessed through EBSCOhost and PubMed with the University of Malta Library platform Hydi. The available and relevant research evidence was identified to answer the proposed research questions. The included studies were limited to papers written in English and published in the last 25 years. They addressed moxibustion and acupuncture in addition to conventional care for breech presentations in pregnant women. Studies addressing treatment derivatives or these interventions but focusing on other outcomes were excluded. Search outcome Twelve RCT studies met the inclusion criteria. Method of appraisal: The STRICTA, CONSORT, and Jadad score frameworks were used to critically appraise the selected studies. Results: Some findings from this review suggest that treatments of moxibustion and acupuncture, in conjunction or separately, are promising. In the other studies, such treatment was found to have a different level of effectiveness. Differences in the methodology of the interventions of the trials may have led to discrepancies in the findings. Conclusion: This literature review underscores the need for more rigorous studies to validate the efficacy and safety of moxibustion and acupuncture in managing breech presentations. While initial findings are promising, comprehensive clinical guidelines and practitioner training are essential for effectively implementing these techniques in prenatal care. Implications: Raising awareness of the effectiveness of moxibustion and acupuncture therapy in prenatal care for abnormal foetal presentations. Detecting gaps in the currently available studies. Encouraging the integration of TCM techniques with conventional obstetric practices to improve maternal and foetal outcomes.