Summaries and commentaries by Adrian White on a selection of recent acupuncture research articles
CLINICAL STUDIES
Acupuncture for induction of labour
‣ Smith CA, Crowther CA, Collins CT, et al. Acupuncture to induce labor: a randomized controlled trial. Obstet Gynecol 2008;112:1067–74.
Acupuncture has long had the reputation for inducing labour — particularly when the uterus is prepared at term — and some unblinded studies had suggested there may be an effect. The proposed mechanisms of action would include release of oxytocin and alteration of autonomic activity. Some authors have even extrapolated to say there is an increased risk of spontaneous abortion from acupuncture in the first trimester, though the current evidence is clearly that there is not.
This randomised controlled trial (RCT) compared acupuncture with sham acupuncture in 364 women for whom an induction of labour was planned for post-term in an otherwise normal pregnancy — singleton with cephalic presentation. Women received two acupuncture or sham acupuncture sessions over a 2-day period before the planned medical/pharmacological induction. The acupuncture was given at LI4, SP6, BL31, BL32, ST36 and LR3. In addition, treatment was given based on any underlying disturbances identified from a Traditional Chinese Medicine (TCM) diagnosis. Strong stimulation was given to induce de qi and needling duration was 30–40 minutes. The sham acupuncture consisted of non-point, non-meridian locations on the sacral area, hand, foot, below the knee and lower leg — all about 1–2 cun away from the named points. The arrangements for blinding of everyone concerned in the trial, except the acupuncturist, were exemplary, and blinding of the women was assessed to be successful.
The results showed no differences between real and sham acupuncture. The decisions on induction showed no differences between groups for prostaglandin induction: relative risk (RR) 1.20, 95% CI 0.96 to 1.51, p = 0.11; for artificial rupture of membranes only: RR 0.93, 95% CI 0.72 to 1.20, p = 0.57; for oxytocin only: RR 0.89, 95% CI 0.60 …
