Acupuncture with manual and electrical stimulation for labour pain: a longitudinal randomised controlled trial.
Acupuncture is commonly used to reduce pain during labour despite contradictory results. The aim of this study is to evaluate the effectiveness of acupuncture with manual stimulation and acupuncture with combined manual and electrical stimulation (electro-acupuncture) compared with standard care in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than standard care, and that electro-acupuncture was most effective.
A longitudinal randomised controlled trial. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals . 303 nulliparous women with normal pregnancies were randomised to: 40 minutes of manual acupuncture (MA), electro-acupuncture (EA), or standard care without acupuncture (SC).
labour pain, assessed by Visual Analogue Scale (VAS).
relaxation, use of obstetric pain relief during labour and post-partum assessments of labour pain. The sample size calculation was based on the primary outcome and a difference of 15 mm on VAS was regarded as clinically relevant, this gave 101 in each group, including a total of 303 women.
Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95% confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95% CI] -3.6-4.8). Fewer number of women in the EA group used epidural analgesia (46%) than women in the MA group (61%) and SC group (70%) (EA vs SC: odds ratio [OR] 0.35; [95% CI] 0.19-0.67).
Acupuncture does not reduce women's experience of labour pain, neither with manual stimulation nor with combined manual and electrical stimulation. However, fewer women in the EA group used epidural analgesia thus indicating that the effect of acupuncture with electrical stimulation may be underestimated. These findings were obtained in a context with free access to other forms of pain relief.
Vixner L et al.
Semin Reprod Med 2017; 35(04): 353-358
Acupuncture for Infertility in Women with Polycystic Ovary Syndrome: What Does It Add?
Acupuncture is a nonpharmacological therapy to induce ovulation in women with polycystic ovary syndrome (PCOS), but not until recently there has been a study reporting the live birth rate following ovulation induction by acupuncture or its potential as an adjuvant to pharmacological ovulation induction. Clomiphene citrate, the first-line treatment for ovulation induction in women with PCOS, was twice as effective at achieving live birth, with no effect of acupuncture alone or in combination with clomiphene. Thus, the findings from the recent randomized control trial do not support acupuncture as an infertility treatment, alone or in combination, in women with PCOS. The recent trial has important clinical implications not only for women with PCOS with an active wish for pregnancy but also for those with no active wish of pregnancy, as acupuncture induces ovulation to a higher degree than no treatment and also relieves other PCOS-related symptoms. This narrative review dissects possible mechanism of action of acupuncture on reproductive function, it discusses stimulation parameters, it discusses the recent findings on live birth, and it also discusses the control situation in potential future acupuncture trials.
Se fler artiklar av professor Elisabeth Stener-Victorin vid Karolinska Institutet.