Impact of acupressure on onset of labour and labour duration: A systematic review

Could a simple manual technique performed by a midwife reduce the incidence of episiotomy and perineal lacerations? A non-randomized pilot study

INTRODUCTION

Women experience medical interventions, episiotomy, and perineal lacerations during childbirth, impacting their physical, psychological, and sexual well-being. This study compares the perineal status of prospective women who had the midwifery intervention of perineal myofascial release during childbirth, to a matched retrospective control sample of women who received standard care during childbirth.

METHODS

A non-randomized pilot study with prospective data collected for 50 women after informed verbal consent was obtained to having the midwifery intervention of perineal myofascial release during childbirth, and the matched retrospective data for the control group of 49 women were collected from a random sample generated from the medical records. Quantitative analyses included descriptive statistics, independent t-tests, regression, and chi-squared analyses. Retrospective trial registration was granted with The Australian New Zealand Clinical Trials Registry ANZTR.

RESULTS

Women were six times (OR=0.15; 95% CI: 0.0-0.37) less likely to have a non-intact perineum and twice (OR=0.44; 95% CI: 0.35-0.56) less likely to have an episiotomy if they were in the intervention group. Chi-squared analysis found no statistically significant differences between groups for normal vaginal birth and instrumental births, excluding cesareans and waterbirth [χ2(1)= -0.37, p=0.542].

CONCLUSIONS

This study found perineal myofascial release benefits women by reducing perineal trauma and episiotomy. However, there were no significant differences in the duration of the active pushing stage of labor or mode of birth. This study has shown some promise in obtaining data for a larger, definitive, randomized controlled trial.

CLINICAL TRIAL REGISTRATION

The study was registered on the Australian New Zealand Clinical Trials Registry ANZTR.

IDENTIFIER

ID ACTRN12623000807651.

Acupuncture before planned admission for induction of labor (ACUPUNT study): A randomized controlled trial: AJOG at a glance

BACKGROUND

The increase in the use of induction of labor is a worldwide phenomenon in the current management of labor and delivery in Western societies, with approximately one out of every four pregnancies undergoing this procedure This has led women to seek various methods for stimulation of the onset of labor. Some data suggest that the use of acupuncture for favoring spontaneous labor onset could reduce the number of inductions of labor procedures. However, good quality evidence in this respect is not yet available.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of acupuncture using a filiform needle to induce spontaneous onset of labor in women with a scheduled induction of labor date and assess the safety and satisfaction of women undergoing acupuncture.

STUDY DESIGN

We conducted a multicenter, randomized, controlled, parallel-arm, unmasked trial in three hospitals in Spain. Eligible participants were women older than 18 years with a singleton pregnancy and a cephalic presentation, scheduled for induction of labor following center-specific protocols. Participants were randomly allocated to one of two groups: the intervention group, which underwent acupuncture sessions for a maximum of four days prior to the scheduled induction of labor, or the control group, which received no specific pre-labor intervention. The primary study outcome was the proportion of women admitted because of spontaneous onset of labor or premature rupture of membranes before or the day of the scheduled induction of labor.

RESULTS

Between November 2017 and June 2023, 212 women were recruited and included in the analysis (106 in the acupuncture group and 106 in the control group). There were no significant differences between the two groups in the baseline demographic characteristics. Regarding the primary outcome, 65.1% (69/106) of women in the acupuncture group and 39.6% (42/106) in the control group were admitted for spontaneous onset of labor or premature rupture of membranes (p < 0.001). Overall, women in the intervention group were admitted 1.25 days before (SD 1.4) their scheduled induction of labor date compared to 0.67 days (SD 1.15) for those in the control group (p=0.001). The median time from recruitment to hospitalization was 4.48 days for the acupuncture group and 5.33 days for the control group (HR 0.52, 95% CI 0.35 - 0.77, p=0.001). There were no significant differences between the two groups regarding the time from admission to delivery or the cesarean delivery rate. Nor were there differences in the rates of maternal or neonatal outcomes, and no maternal or fetal deaths occurred in either group.

CONCLUSION

Acupuncture with filiform needles, administered 4 days prior to scheduled induction of labor increased admission for spontaneous onset of labor and premature rupture of membranes before the induction of labor date.

The Effect of Ice Massage Applied to the SP6 Point on Labor Pain, Labor Comfort, Labor Duration, and Anxiety: A Randomized Clinical Trial

INTRODUCTION

Acupressure and cold application are nonpharmacologic methods that midwives can use for labor pain. The purpose of this study was to determine the effects of ice massage applied to the SP6 acupressure point during labor on labor pain, labor comfort, labor duration, and anxiety.

METHODS

A single-masked, randomized controlled trial was conducted with 100 nulliparous women, including 50 in the intervention group and 50 in the control group. Rotational ice massage was applied to the SP6 point on both legs of the pregnant women in the intervention group at 4 to 5 cm, 6 to 7 cm, and 8 to 9 cm dilation amounts during 3 contractions. Routine oxytocin was administered to all pregnant women to promote progress of labor. Standard midwifery care was provided to the control group. Data were collected using a Personal Information Form, the Visual Analog Scale (VAS), a partograph form, the Childbirth Comfort Questionnaire (CCQ), and the State-Trait Anxiety Inventory State subscale.

RESULT

The VAS pain scores of the pregnant women in the intervention group were significantly lower compared with the control group following the intervention at dilatations of 4 to 5 cm, 6 to 7 cm, and 8 to 9 cm (P = .001, P = .003, P <.001, respectively). The total CCQ and comfort level scores of the pregnant women in the intervention group at 8 to 9 cm cervical dilatation were significantly higher than the control group (P = 0.044, P = .027, respectively). Additionally, as the anxiety levels of the pregnant women increased, their total comfort scores decreased (P <.05).

DISCUSSION

Ice application to the SP6 point during stage 1 of childbirth reduced labor pain, increased comfort, and reduced anxiety levels. No adverse events were found in the intervention group with ice massage applied to the SP6 point. Therefore, this method can be used as a safe and effective midwifery intervention in childbirth.

The role of acupuncture in the present approach to labor induction: a systematic review and meta-analysis

OBJECTIVE

This study aimed to evaluate the bibliographic references available on the contribution of acupuncture as a strategy to avoid labor induction and the methodology used; and explore the characteristics of the population and the results of the intervention in order to direct the design of future studies.

DATA SOURCE

A systematic search for publications between January 2000 and September 2023 of the CENTRAL, PubMed, CINAHL, SCOPUS, ClinicalTrials.gov, and EUDRACT databases was performed.

STUDY ELIGIBILITY CRITERIA

We included randomized clinical trials of pregnant women who underwent acupuncture before labor induction with a filiform needle or acupressure, including at least 1 of the following outcomes: spontaneous labor rate, time from procedure to delivery, and cesarean delivery rate. Articles published in English or German language were included.

METHODS

Whenever possible, a meta-analysis using RevMan software was performed using a random effects model with the I2 statistic because important heterogeneity in the different acupuncture treatments was expected. When enough data were available, the effect of the participants' characteristics on the results of the interventions were explored using the following subgroups: 1-Age (≥35 vs <35 years), and 2- body mass index (≥30 vs <30 kg/m2). When a meta-analysis was not possible, a narrative synthesis of the results was performed. The quality of the evidence was assessed using GRADE.

RESULTS

Seventeen studies including 3262 women fulfilled our inclusion criteria. The meta-analysis showed no statistically significant differences between groups for outcomes (relative risk, 1.00; 95% confidence interval, 0.91-1.10; I2, 11%) comparing acupuncture vs sham acupuncture. However, there was a statistically significant increase in the spontaneous onset of labor rate favoring acupuncture vs no acupuncture (relative risk, 1.12; 95% confidence interval, 1.03-1.23; I2, 25%). Regarding the age analysis, no differences between groups were observed in the spontaneous labor rate and cesarean delivery rate for acupuncture vs sham and acupuncture vs no acupuncture comparisons (difference between groups, P>.05).

CONCLUSION

This study suggests that acupuncture may be beneficial in reducing the rate of induction of labor; however, well-designed randomized controlled trials are necessary. Maternal age ≥35 years and a high body mass index were underrepresented, and the findings may not be representative of the current population in our context.

The Effect of Pelvic Rocking Exercise with a Birth Ball and SP6 Acupressure on Duration of the First and Second Stage of Labor

Background: Long duration of labor increases the pain that a mother experiences. Several non-pharmacological methods, such as pelvic rocking exercises and SP6 acupressure, have been discovered to reduce pain and accelerate labor duration. It needs to be clarified which of the two methods is more effective.Purpose: This study aimed to assess the effectiveness of pelvic rocking exercise with a birth ball and SP6 acupressure in shortening the duration of the active phase in the first and the second stage of labor.Methods: This study used a quasi-experimental design involving 64 mothers in the first stage of normal delivery who were recruited using propensity score matching sampling. The participants were divided into two intervention groups (the pelvic rocking exercise with a birth ball and SP6 acupressure). Each respondent in the two intervention groups was monitored for progress of labor during the active phase in the first stage using a partograph starting from cervical dilatation of 4 cm to 10 cm. The duration of the second stage was assessed by calculating the length of time from cervical dilatation of 10 cm to the delivery of the entire baby. The Mann-Whitney U test was performed to assess the difference between the two interventions in the two stages of labor assessed.Results: There was a difference in the duration of labor in the first stage (p=0.00) and the second stage (p=0.001) between the groups given the pelvic rocking exercise with a birth ball and the SP6 acupressure. The pelvic rocking exercise with a birth ball was found to be more effective in shortening the duration of the active phase in the first stage (Mean rank=19.83) and the second stage of labor (Mean rank=24.56) compared to SP6 acupressure (Mean rank of the first stage=45.17 and Mean rank of the second stage=40.44).Conclusion: The pelvic rocking exercise was found to be more effective compared to SP6 acupressure in shortening the duration of the active phase in the first and the second stage of labor. Pelvic rocking exercise can be implemented to help accelerate labor duration so that mothers can feel more comfortable during the labor.

Complementary and Integrative Health Practices in a Brazilian Freestanding Birth Center: A Cross-Sectional Study

The study aimed to analyze the use of complementary and integrative health practices (CIHPs) during labor and birth in a freestanding birth center. A total of 28 different CIHPs were applied with or used by laboring women. The most adopted CIHPs were mind-body practices (99.9%) and natural products (35.5%), mostly used by primiparous women (P <.05). Adopting CIHPs can increase care quality, increase positive experiences during childbirth, and promote evidence-based choices.

Acupuncture versus Lornoxicam in the Treatment of Acute Renal Colic: A Randomized Controlled Trial

Objective

To compare the analgesic efficacy and safety of acupuncture and lornoxicam in acute renal colic (ARC).

Design, Setting, Participant

A randomized, double-blind, parallel-controlled, single-centered trial was conducted at Susong County People’s Hospital from October 2019 to November 2020. Eighty-four patients with ARC were randomly divided into lornoxicam group (Group L) and acupuncture group (Group A). Group A was treated with acupuncture at Sanyinjiao (SP6), Yinlingquan (SP9) and normal saline, and Group L was treated with sham acupuncture at SP6, SP9 and lornoxicam.

Main Outcome Measures

Visual analogue scale (VAS) scores and adverse reactions such as nausea and dizziness were recorded within 5, 10, 15, 20 and 40 minutes after treatment. The main outcome of this study was the short-term effective (STE) rate, the secondary outcome was the onset time, and the safety index was incidence of adverse reactions.

Results

A total of 80 patients completed this study, including 41 patients (21 males and 20 females) in Group L and 39 patients (21 males and 18 females) in Group A. Group A exhibited lower scores versus group L after treatment (P < 0.05). The overall STE of group L was 61.00% (25/41), significantly lower than group A [84.62% (33/39)] (P < 0.001). There was no difference in the incidence of adverse reactions between group A [2.6% (1/39)] and group L [7.3% (3/41)] (P = 0.616). The ordered logistic regression analysis showed patients receiving acupuncture therapy are more likely to be cured [OR = 2.887, 95% CI: (1.190, 7.000), P = 0.019].

Conclusion

Acupuncture at SP6, SP9 and intramuscular injection of lornoxicam can effectively and safely relieve ARC, but the former has faster and better analgesic effect. Moreover, the incidence of adverse reactions was similar between the two treatments. This acupuncture therapy is recommended as a complementary therapy for ARC.

Cervical ripening and labour induction: A critical review of the available methods

Induction of labour is one of the most common interventions experienced by pregnant women. There are two overlapping components to labour induction, which include cervical ripening and the initiation of regular contractions. A large number of clinical studies have been conducted for evaluating the methods used for induction of labour, their effectiveness and safety, and pregnancy outcomes. Randomised controlled trials (RCTs) provide the strongest form of evidence for clinical practice. These data are brought together in systematic reviews and have been incorporated into national and international guidelines. Despite this, there is considerable variation in the recommendations between guidelines. Heterogeneity between studies, inconsistency in the definitions of trial outcomes, and underpowered sample size contribute to the difficulty in making robust recommendations. There are pharmacological and non-pharmacological approaches that can be compared with each other and with placebo or no treatment. There are also complementary therapies that may appeal to women but lack evidence of their effectiveness. These issues have been addressed in the current chapter, with a critical review of the research evidence presented in clinical trials and systematic reviews.

Labour induction massage: A thematic content analysis of Australian massage therapists' website pages

BACKGROUND AND PURPOSE

There is limited evidence on the efficacy and safety of induction massage; however, there are some massage therapists in Australia who offer induction massage. The aim of this paper is to determine the information being provided to consumers on websites pages of Australian massage therapists who provide 'induction massage'.

MATERIALS AND METHODS

A qualitative summative content analysis methodology employing both manifest and latent content analysis was used to examine website pages of Australian massage therapists offering 'induction massage'.

RESULTS

Twenty-eight websites met the criteria for inclusion. The qualitative theme was a façade of hope with three subthemes: a) misconception and equivocation, b) marketing scieneploitation and c) lack of empowerment.

CONCLUSION

While there were only a small number of websites that provided induction massage, these webpages generally failed to provide accurate and complete information and used deceptive and misleading statements and language that made 'induction massage' appear more efficacious and legitimate than current evidence suggests it is, thus potentially giving false hope to potential consumers.

Anatomical characterization of acupoint large intestine 4

Large intestine 4 (LI4) is a major acupoint used in various treatments in acupuncture and Traditional Chinese Medicine. There are structures associated within the region of LI4 that have three-dimensional anatomical relationship that needs further characterization. The aims of this study were: (a) to observe the anatomical variation of structures around LI4; (b) to observe specific overlap of structures around LI4. A 1256 mm² area was dissected in 25 cadaveric hands around LI4. Nondissected areas were marked with pins as reference points. Dissections were photographed with a fixed camera. Subsequently, images were imported to Adobe Photoshop 2020 and analyzed. Descriptive statistics and graphs were compiled using Graphpad Prism 2020. The tributaries of the dorsal venous plexus (22.3%), branches of superficial radial nerve (18.9%), first dorsal interosseous muscle (52.4%), arterial branches in the first interosseous space (10.2%), and deep ulnar nerve (4.0%) were observed in the area of LI4. One branch of the superficial radial nerve passed through LI4. The deep ulnar nerve was found in the bulk of the first dorsal interosseous muscle. Several structures observed intersected at LI4. The superficial radial nerve interweaved with the dorsal venous plexus superficially. The deep ulnar nerve passed anterior to the second palmar metacarpal artery before entering into the first dorsal interosseous muscle. These results provide anatomical evidence and variation into the vascular contributions at LI4.

A Systematic Review and Meta-Analysis of the Effect of Acupressure on Relieving the Labor Pain

BACKGROUND

Numerous studies have been conducted on the effect of acupressure on labor pain, some of which have reported conflicting results. Thus, the present study was performed to critically review the previous studies related to the effect of acupressure administered during labor for relieving labor pain.

MATERIALS AND METHODS

In this study, databases of the Cochrane Central Register of the Controlled Trials, PubMed/MEDLINE, Scopus, and Web of Science were searched from their establishment until November 5, 2019. All the Randomized Controlled Trials (RCTs) that had compared the use of acupressure with either placebo or nonintervention for relieving the labor pain were included in the study. Meta-analysis was performed using the Comprehensive Meta-Analysis (CMA) software Version 2. The random-effects model was used for pooling the effect sizes across the included studies. The p value <0.05 was considered as statistically significant.

RESULTS

Totally, 5853 primary papers were identified in the search, which were narrowed down to 22 studies. The results of meta-analysis showed that the acupressure decreased the labor pain in the intervention group vs. control (-1.67 [-2.29 to -1.05], z = -5.25, p < 0. 001) (Q-value = 788.98, p < 0.001, I-squared = 96.83). No publication bias was found in the included studies (Egger's regression intercept = -1.02, p = 0.76).

CONCLUSIONS

Although the findings of this meta-analysis showed that the acupressure significantly reduced the labor pain during the active phase of labor compared to the nonintervention or placebo; considering that the quality of the included studies was generally moderate, rigorous RCTs with better design and higher quality are needed to obtain definitive conclusions.

Acupressure for labor pain management: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To evaluate the efficacy/effectiveness of acupressure as an adjunct to standard procedures during labor and delivery, compared with standard procedures with/without sham acupressure, in randomized controlled trials (RCTs).

METHODS

Ten main databases were searched from their inception until 31 January 2018. Two reviewers independently extracted data concerning the effects of acupressure on pain intensity, labor duration, mode of delivery, use of medications and adverse events. A meta-analysis of these measures was performed using RevMan 5.3. Pooled standardized mean differences (SMDs) or odds ratios (ORs) for the above outcomes were estimated with a fixed or random effects model, according to the heterogeneity.

RESULTS

A total of 13 RCTs including 1586 enrolled patients met the eligibility criteria. Acupressure plus standard procedures (ASP) for labor management significantly reduced pain sensation, compared with sham acupressure plus standard procedures (SASP) and standard procedures (SP) alone. The analgesic effect of acupressure was immediate and persisted for at least 60 min (all p < 0.01). Compared with the untreated control groups, the acupressure group had a shorter duration of labor, especially the first stage of labor (SMD = -0.76, 95% confidence interval (CI) = -1.10 to -0.43; p < 0.001; I² = 74%) and second stage of labor (SMD = -0.37, 95% CI = -0.59 to -0.18; p < 0.001; I² = 0%). Data suggesting that acupressure reduced the Cesarean section rate was inconclusive. The use of pharmacologic agents (oxytocin and analgesics) did not differ between the ASP, SASP and SP groups. No adverse events were reported in this limited number of studies.

CONCLUSION

Moderate evidence indicates that acupressure may have promising effects on labor pain and duration. However, high-quality trials to verify these findings are warranted.

Effects of ear and body acupressure on labor pain and duration of labor active phase: A randomized controlled trial

OBJECTIVES

This study sought to compare the effects of multi-point ear and body acupressure on labor pain and the duration of labor active phase.

DESIGN

Three-armed randomized controlled trial.

SETTING

Kowsar Hospital, Qazvin, Iran.

INTERVENTION

Participants in the body acupressure group received acupressure on GB21, GB30, BL32, LI4, and SP6 points, each for two minutes, at cervical dilation of four, six, and eight centimeters. For participants in the ear acupressure group, adhesive auriculotherapy-specific Vaccaria seeds were attached to their auricles on the zero, genitalia, Shen Men, thalamic, and uterine 1 and 2 acupoints. The seeds were compressed every thirty minutes, each time for thirty seconds. Participants in the control group received routine care services.

MAIN OUTCOME MEASURES

Labor pain intensity was assessed using a visual analogue scale at cervical dilation of four and ten centimeters.

RESULTS

While there was no significant difference between mean scores of pain among three groups, mean score of labor pain in both acupressure groups was significantly less than that in the control group (P < 0.001). However, the difference between the acupressure groups was not statistically significant (P = 0.12). Moreover, the duration of labor active phase in the ear acupressure group was significantly less than those in the body acupressure and the control groups (P < 0.001).

CONCLUSION

Ear acupressure was significantly effective in reducing labor pain and shortening labor active phase. However, body acupressure solely reduces labor pain. Therefore, ear acupressure can be used to reduce labor pain and shorten labor active phase.

Comparing the effect of auricular acupressure and body acupressure on pain and duration of the first stage of labor: study protocol for a randomized controlled trial

BACKGROUND

Labor pain is one of the leading causes of fear of childbirth. Acupressure is a non-pharmacological pain relief method that has shown promising results in relieving this pain. The present study is designed to compare the effects of body acupressure at multiple points and auricular acupressure on the pain and duration of labor.

METHODS/DESIGN

In a randomized controlled trial, 90 primigravida women who attend for childbirth will be randomly assigned to one of three groups (intervention groups of either body acupressure or auricular acupressure; control, consisting of routine care). Computer-generated six-block randomization techniques will be used to determine the allocation sequence with a 1:1:1 ratio. To hide the allocation, the type of intervention will be written according to the generated sequence and put in opaque envelopes; these as well as questionnaires will be encoded. The pain score for all participants will be measured at the peak uterine contraction at 4-cm cervical dilation and at 10-cm dilation based on a visual analog scale (VAS). The duration of the active phase of labor in these groups will be recorded too. Data will be imported into SPSS-16 software. First, normality of the data distribution will be investigated. To compare labor duration among the research groups, ANOVA will be used, which will be followed, in case of significance, by the Scheffe post hoc test. Furthermore, Chi-squared test will be used to compare the categorized demographic variables and ANOVA or Kruskal-Wallis tests will be used to compare the quantitative variables in the studied groups. A significance level of 0.05 is considered significant.

DISCUSSION

In this study the effect of auricular acupressure and body acupressure on pain and duration of first stage of labor will be compared.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials, IRCT20180218038789N1. Registered 2018-03-04; pre result.

Complementary therapy and alternative medicine: effects on induction of labour and pregnancy outcome in low risk post-dates women

Background

Complementary therapy and Alternative medicine (CAM) is used worldwide for many ailments and is a popular option amongst pregnant women for general wellbeing and managing symptoms. Many studies investigating the use of CAM in the antenatal and intrapartum period have been conducted however there is a lack of evidence regarding its effects on induction of labour and delivery. We established a post-dates clinic comprising of an antenatal check and CAM for low risk pregnant women to determine the impact of CAM on these outcomes.

Methods

This was a cohort study with convenience sampling. A total of 1044 women were included. 397 received a combination of three CAM techniques (acupressure, reflexology and aromatherapy) and 647 women received standard clinical practice. The primary outcome was rate of induction of labour and secondary outcomes such as rates for epidural, length of labour, oxytocin use for induction or augmentation of labour, mode of delivery, blood loss during delivery, postpartum haemorrhage, significant perineal trauma, shoulder dystocia and admission of the baby to a special care unit were analysed.

Findings

CAM did not have an effect on rates of induction of labour in nulliparous or multiparous women attending the post-dates clinic. However, we noted that nulliparous women who received CAM had shorter labours (mean 8.4 vs 10 h, p = 0.0002), less oxytocin augmentation (23% vs 35%, p = 0.0002), lower epidural rates (41% vs 50.5%, p = 0.02) and reduced blood loss regardless of mode of delivery (mean reduction 82ml, p = 0.03; 95%CI = -159 to -5). There were no significant differences in secondary outcomes when CAM was used in multiparous women apart from a 5.3 times increased risk of significant perineal trauma (6% vs 2%, p = 0.004) and those who had their labours induced after CAM had a higher risk of requiring an emergency caesarean section (5% vs 1%, p = 0.012). There was no difference on shoulder dystocia and neonatal admissions rates with CAM.

Conclusion

There is no reduction in induction of labour rates with the use of CAM. The other effects of CAM on labour and delivery outcomes are varied and potentially only beneficial in a selected group of women. Further research must be carried out before making any clear recommendations on its use.

Efficacy of acupressure to prevent adverse reactions to anti-tuberculosis drugs: Randomized controlled trials

AIM

To determine whether acupressure can prevent or relieve the adverse drug reactions (ADRs) of anti-tuberculosis drugs.

BACKGROUND

People receiving drug treatment for TB often experience ADRs that may cause them to stop taking their medication. Acupressure is a form of traditional Chinese medicine that can be applied to alleviate or prevent disease symptoms.

DESIGN

A double-blinded, repeated-measures clinical trial in hospitals in Taiwan was carried out from April 2015 - May 2017.

METHODS

Convenience sampling was used to select 32 people (15 for the experimental group and 17 for the control group) aged >20 years who were taking anti-tuberculosis drugs. The people were randomized to receive 4-week of true acupressure and 4-weeks of sham acupressure. Acupressure therapy was given by a researcher in all cases. Both groups received treatment once per day on weekdays, with 15 min for each acupressure session. Outcomes (gastrointestinal irritation and adverse skin reactions) were assessed according to the people feedback and the physicians' recordings during the treatment course, and during monthly follow-up visits for 6 months thereafter.

RESULTS

Both groups typically experienced gastrointestinal irritation and adverse skin reactions within 2 months of beginning anti-tuberculosis drug treatment. The 4-weeks intervention involving relevant acupressure points successfully relieved both types of side effects in both immediate and delayed manner.

CONCLUSIONS

When correctly implemented, acupressure can prevent and relieve the ADRs of anti-tuberculosis drugs, and motivate people to complete their treatment course.

Acupuncture in Postdate Pregnancy Management

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.

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.

Acupuncture or acupressure for induction of labour

BACKGROUND

This is one of a series of reviews of methods of cervical ripening and labour induction. The use of complementary therapies is increasing. Women may look to complementary therapies during pregnancy and childbirth to be used alongside conventional medical practice. Acupuncture involves the insertion of very fine needles into specific points of the body. Acupressure is using the thumbs or fingers to apply pressure to specific points. The limited observational studies to date suggest acupuncture for induction of labour has no known adverse effects to the fetus, and may be effective. However, the evidence regarding the clinical effectiveness of this technique is limited.

OBJECTIVES

To determine, from the best available evidence, the effectiveness and safety of acupuncture and acupressure for third trimester cervical ripening or induction of labour.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2016), PubMed (1966 to 25 November 2016), ProQuest Dissertations & Theses (25 November 2016), CINAHL (25 November 2016), Embase (25 November 2016), the WHO International Clinical Trials Registry Portal (ICTRP) (3 October 2016), and bibliographies of relevant papers.

SELECTION CRITERIA

Randomised controlled trials comparing acupuncture or acupressure, used for third trimester cervical ripening or labour induction, with placebo/no treatment or other methods on a predefined list of labour induction methods.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked them for accuracy. The quality of the evidence was assessed using GRADE.

MAIN RESULTS

This updated review includes 22 trials, reporting on 3456 women. The trials using manual or electro-acupuncture were compared with usual care (eight trials, 760 women), sweeping of membranes (one trial, 207 women), or sham controls (seven trials, 729 women). Trials using acupressure were compared with usual care (two trials, 151 women) or sham controls (two trials, 239 women). Many studies had a moderate risk of bias.Overall, few trials reported on primary outcomes. No trial reported vaginal delivery not achieved within 24 hours and uterine hyperstimulation with fetal heart rate (FHR) changes. Serious maternal and neonatal death or morbidity were only reported under acupuncture versus sham control. Acupuncture versus sham control There was no clear difference in caesarean sections between groups (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.56 to 1.15, eight trials, 789 women; high-quality evidence). There were no reports of maternal death or perinatal death in the one trial that reported this outcome. There was evidence of a benefit from acupuncture in improving cervical readiness for labour (mean difference (MD) 0.40, 95% CI 0.11 to 0.69, one trial, 125 women), as measured by cervical maturity within 24 hours using Bishop's score. There was no evidence of a difference between groups for oxytocin augmentation, epidural analgesia, instrumental vaginal birth, meconium-stained liquor, Apgar score < 7 at five minutes, neonatal intensive care admission, maternal infection, postpartum bleeding greater than 500 mL, time from the trial to time of birth, use of induction methods, length of labour, and spontaneous vaginal birth. Acupuncture versus usual care There was no clear difference in caesarean sections between groups (average RR 0.77, 95% CI 0.51 to 1.17, eight trials, 760 women; low-quality evidence). There was an increase in cervical maturation for the acupuncture (electro) group compared with control (MD 1.30, 95% CI 0.11 to 2.49, one trial, 67 women) and a shorter length of labour (minutes) in the usual care group compared to electro-acupuncture (MD 124.00, 95% CI 37.39 to 210.61, one trial, 67 women).There appeared be a differential effect according to type of acupuncture based on subgroup analysis. Electro-acupuncture appeared to have more of an effect than manual acupuncture for the outcomes caesarean section (CS), and instrumental vaginal and spontaneous vaginal birth. It decreased the rate of CS (average RR 0.54, 95% CI 0.37 to 0.80, 3 trials, 327 women), increased the rate of instrumental vaginal birth (average RR 2.30, 95%CI 1.15 to 4.60, two trials, 271 women), and increased the rate of spontaneous vaginal birth (average RR 2.06, 95% CI 1.20 to 3.56, one trial, 72 women). However, subgroup analyses are observational in nature and so results should be interpreted with caution.There were no clear differences between groups for other outcomes: oxytocin augmentation, use of epidural analgesia, Apgar score < 7 at 5 minutes, neonatal intensive care admission, maternal infection, perineal tear, fetal infection, maternal satisfaction, use of other induction methods, and postpartum bleeding greater than 500 mL. Acupuncture versus sweeping if fetal membranes One trial of acupuncture versus sweeping of fetal membranes showed no clear differences between groups in caesarean sections (RR 0.64, 95% CI 0.34 to 1.22, one trial, 207 women, moderate-quality evidence), need for augmentation, epidural analgesia, instrumental vaginal birth, Apgar score < 7 at 5 minutes, neonatal intensive care admission, and postpartum bleeding greater than 500 mL. Acupressure versus sham control There was no evidence of benefit from acupressure in reducing caesarean sections compared to control (RR, 0.94, 95% CI 0.68 to 1.30, two trials, 239 women, moderate-quality evidence). There was no evidence of a clear benefit in reduced oxytocin augmentation, instrumental vaginal birth, meconium-stained liquor, time from trial intervention to birth of the baby, and spontaneous vaginal birth. Acupressure versus usual care There was no evidence of benefit from acupressure in reducing caesarean sections compared to usual care (RR 1.02, 95% CI 0.68 to 1.53, two trials, 151 women, moderate-quality evidence). There was no evidence of a clear benefit in reduced epidural analgesia, Apgar score < 7 at 5 minutes, admission to neonatal intensive care, time from trial intervention to birth of the baby, use of other induction methods, and spontaneous vaginal birth.

AUTHORS' CONCLUSIONS

Overall, there was no clear benefit from acupuncture or acupressure in reducing caesarean section rate. The quality of the evidence varied between low to high. Few trials reported on neonatal morbidity or maternal mortality outcomes. Acupuncture showed some benefit in improving cervical maturity, however, more well-designed trials are needed. Future trials could include clinically relevant safety outcomes.

Acupuncture and Acupressure in Labor

Acupuncture and acupressure, 2 modalities of Traditional Chinese Medicine, are based on reducing pain and symptoms of disease through balancing yin and yang. Acupuncture and acupressure have been used in China for reduction of labor pain, labor augmentation, and other intrapartum indications for more than 2 millennia. This article presents a review of the current literature that has addressed the effects of acupuncture and acupressure on intrapartum events. Studies of acupuncture have demonstrated that acupuncture may reduce labor pain, the use of pharmacologic agents, the use of forceps and vacuum-assisted births, and the length of labor. Studies that examined the effect of acupuncture on labor that is induced or augmented for premature rupture of membranes have found that acupuncture may increase the degree of cervical ripening but does not reduce the amount of oxytocin or epidural analgesia administration, nor does it shorten length of induced labor. Acupressure may reduce labor pain and labor duration, but acupressure has not been found to increase cervical ripening or induce labor. There are insufficient studies about acupuncture and acupressure and their effects on labor at this time, and there is need for further research. Areas of uncertainty include efficacy, optimal point selection, best techniques, and length of time for point stimulation.