Sommaire

general obstetrics and gynaecology

gynéco-obstétrique générale : évaluation de l'acupuncture

1. Systematic Reviews and Meta-Analysis

Tingting L, Tongou L, Mingfu L. Effectiveness and safety of acupuncture in treatment of pregnancy-related symptoms: a systematic review and Meta-analysis. J Tradit Chin Med. 2024 Feb;44(1):16-26. https://doi.org/10.19852/j.cnki.jtcm.20231204.006

Objective To systematically evaluate the efficacy and safety of acupuncture (AM) in the treatment of pregnancy-related symptoms such as acute vomiting during pregnancy.
Methods We comprehensively searched the available literature up to November 2021, including PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure Database, for randomized controlled trials (RCTs) on AM for the treatment of severe vomiting, insomnia, pharyngeal and pelvic pain, mood abnormalities, and dyspepsia during pregnancy.
Results Sixteen RCTs with a cumulative sample size of 1178 cases were included. Of these, 964 patients were included in the Meta-analysis. The Meta-analysis results showed that AM was more efficient than Western medicine in treating discomfort during pregnancy [odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.11, 1.28), P < 0.01]. AM was better than the control group in improving the visual analog scale scores [standard mean difference (SMD) = 0.62, 95% CI(0.53, 0.71), P < 0.01]. AM was superior to the control group in improving Numerical Rating Scale (NRS) symptom scores [OR = 7.31, 95% CI(3.36, 15.94), P < 0.01]. There was no significant difference in adverse effects between the AM and sham-AM groups and the analgesic drug group [OR = 0.70, 95% CI(0.39, 1.28), P = 0.25], but the treatment and control groups had mild adverse effects with a low incidence.
Conclusions AM is more effective than other treatments or pharmacotherapy alone in the treatment of pregnancy-related symptoms, and is relatively safe. However, the quality of the included trials was rather poor, and high-quality studies are required to confirm our findings.

1.2. Smith 2010

Smith CA, Carmady B. Acupuncture to treat common reproductive health complaints: an overview of the evidence. Auton. Neurosci. 2010;157(1-2):52-6. 156059

BackgroungWomen specific health complaints are common, and women are higher users of complementary therapies and medicines. Acupuncture is one modality used by women. The aim of this paper was to summarise the evidence from scientific trials and systematic reviews assessing the effectiveness of acupuncture to treat the most common women specific reproductive health complaints.
MethodsWe conducted a search of the major databases PubMed, CINAHL, and the Cochrane Library from their inception to Sept 2009, to obtain English language texts of randomised controlled trials (RCTs) and systematic reviews. The following English Australian search terms were used: acupuncture and period pain or dysmenorrhea, or premenstrual syndrome, or poly cystic ovarian syndrome/PCOS, or menstrual headache, or irregular periods/menstruation, or amenorrhea, or heavy menses/periods, or menorrhagia, or menopause, and randomised controlled trial and systematic review. Both authors extracted data and reviewed each trial and systematic review for methodological quality.
ResultsFive systematic reviews were included, and six RCTs. The symptoms of the menopause and dysmenorrhea have been subject to greater clinical evaluation through RCTs, and the evidence summarised in systematic reviews, than any other reproductive health complaint. The evidence for acupuncture to treat dysmenorrhea and menopause remains unclear, due to small study populations and the presence of methodological bias. Acupuncture to treat PMS, PCOS and other menstrual related symptoms is under-studied, and the evidence for acupuncture to treat these conditions is frequently based on single studies.
ConclusionsFurther research is needed.

1.3. Smith 2009

Smith CA, Cochrane S. Does acupuncture have a place as an adjunct treatment during pregnancy? a review of randomized controlled trials and systematic reviews. Birth. 2009;36(3):246-53. [154029].

BackgroundComplementary medicine has become popular throughout many Western countries and is widely used by women across all stages of their life cycle. Acupuncture is used by women during their pregnancy, and research suggests that acupuncture may be used as an adjunct to their existing conventional care. The aim of this paper was to summarize the evidence examining the effectiveness of acupuncture during pregnancy and birthing, and to discuss its role as an adjunct treatment.
Methods We conducted a systematic literature search using several electronic databases. We included all placebo-controlled randomized trials of parallel design, and systematic reviews that evaluated the role of acupuncture during pregnancy and birthing. A critical appraisal of clinical trials and systematic reviews was undertaken.
Results The summarized findings indicated a small but growing body of acupuncture research, with some evidence suggesting a benefit from acupuncture to treat nausea in pregnancy. Findings from the review also highlighted promising evidence for the effectiveness of acupuncture to manage back and pelvic pain, acupuncture-type interventions to induce change in breech presentation, and pain relief in labor. The methodological quality of recent trials has improved, and the quality of systematic reviews was high.
ConclusionsInterest is growing in the use of acupuncture to treat some complaints during pregnancy and childbirth, and evidence is beginning to consolidate that acupuncture may assist with the management of some complaints during pregnancy. However, definitive conclusions about its effectiveness cannot be reached and further research is justified.

1.4. White 2003

White AR. a review of controlled trials of acupuncture for women's reproductive health care. J Fam Plann Reprod Health Care. 2003;29(4):233-6. [117517].

BackgroundAcupuncture as a therapy, and acupressure as self-treatment, are increasingly widely used for gynaecological conditions, and this study aims to review the scientific literature on their effectiveness.
MethodA systematic review of controlled trials of acupuncture or acupressure for gynaecological conditions, published in a European language.
SynthesisNo studies in mastalgia, menorrhagia, pelvic pain, premenstrual syndrome or vulvodynia met the inclusion criteria. Four studies, two of which were patient-blinded, of acupuncture or acupressure for dysmenorrhoea suggest that it may have an effect. Three studies of acupuncture given at various stages of infertility treatment are promising, but none was patient-blind. Two studies of acupuncture for menopausal symptoms showed no effect during the treatment period when compared with sham acupuncture, and a third study showed no effect on hypertension in postmenopausal women, though some improvement in symptoms was noted.
ConclusionIn view of the small number of studies and their variable quality, doubt remains about the effectiveness of acupuncture for gynaecological conditions. Acupuncture and acupressure appear promising for dysmenorrhoea, and acupuncture for infertility, and further studies are justified.

2. Overviews of Systematic Reviews

2.1. Bergamo 2018

Bergamo TR, Latorraca COC, Pachito DV , Martimbianco ALC, Riera R. Findings and methodological quality of systematic reviews focusing on acupuncture for pregnancy-related acute conditions. Acupuncture in Medicine. 2018;36(3):146-152. [201325].

Introduction Major concerns regarding the use of medication during pregnancy justify the need for safer interventions. Acupuncture is an emerging alternative for several clinical conditions during this period. The objective of this study is to summarise evidence derived from systematic reviews (SRs) focusing on acupuncture for pregnancy-related acute conditions.
MethodsReview of SRs. A systematic literature search was carried out in several electronic databases, aiming to include all SRs assessing the effects of acupuncture for acute conditions during pregnancy. Methodological quality and quality of the publication/reporting of each SR were assessed by the application of AMSTAR (Assessing the Methodological Quality of Systematic Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), respectively.
ResultsThe initial search retrieved 11 492 records, of which 16 SRs met our inclusion criteria. The average AMSTAR score was 7.3, the lowest score being 3 and the highest 11. The lowest PRISMA score was 12, the highest 25, and the average PRISMA score was 19.9. The results support the proposal that acupuncture might be considered an option for alleviating pain during labour, for correcting breech presentation, and for managing pelvic and back pain during pregnancy. There is insufficient evidence to recommend acupuncture for inducing labour, managing nausea and vomiting in early pregnancy, improving sleep quality, controlling nausea and vomiting associated with Caesarean delivery, and managing urinary infection.
Conclusions Acupuncture might be an option for alleviating pain during labour, for correcting breech presentation, and for managing pelvic and back pain during pregnancy. More studies are needed to confirm the effects of acupuncture for other pregnancy-related acute conditions.

2.2. Buchberger 2018

Buchberger B, Krabbe L. Evaluation of outpatient acupuncture for relief of pregnancy-related conditions. Int J Gynaecol Obstet.. 2018;141(2):151-158. [168756].

Background Acupuncture is a non-pharmacological option to relieve pregnancy-related complaints.
Objectives To critically appraise the best available evidence for the use of acupuncture in outpatient care.
MethodsSEARCH STRATEGY: The MEDLINE, Cochrane Library, and Centre for Reviews and Dissemination databases were searched for English-language and German-language papers published from January 1980 to March 2017 using search terms related to pregnancy combined with 'acupuncture'. SELECTION CRITERIA: Systematic reviews and randomized controlled trials (RCTs) comparing non-pharmacological treatments in unselected or low-risk pregnant women. DATA COLLECTION AND ANALYSIS: Quality was assessed using a checklist (A Measurement Tool to Assess Systematic Reviews) and the Cochrane risk of bias tool. Meta-analyses were also performed.
Main results High-quality systematic reviews (n=5) and RCTs with low risk of bias (n=3) were identified. The systematic reviews were based on single studies, with small sample sizes, that showed a benefit of acupuncture for evening pelvic pain; pelvic and low-back pain; nausea; functional disability; and sleep quality. Contradictory results were found in the RCTs regarding cesarean delivery; time to delivery; spontaneous labor; fetal distress; and Apgar score. Data pooling emphasized the heterogeneity of results.
ConclusionsEvidence to support the use of acupuncture for relief of pregnancy-related conditions was limited.

2.3. Kang 2011

Kang HS, Jeong D, Kim DI, Lee MS. The use of acupuncture for managing gynaecologic conditions: an overview of systematic reviews. Maturitas. 2011;68(4):346-54. [156178].

BackgroundAcupuncture is increasingly popular for the treatment of many medical complaints, including gynaecologic conditions.
ObjectivesThe aim of this study was to summarise the evidence from systematic reviews (SRs) and meta-analyses assessing the efficacy of acupuncture in treating common gynaecologic conditions.
MethodsSix electronic databases, including two major English-language databases (PubMed and the Cochrane Library) and four Korean databases, were systematically searched for SRs and meta-analyses concerned with acupuncture and common gynaecologic diseases. The following English search terms were used: (gynaecologic disease in MeSH terms) AND (acupuncture or acup*) AND (systematic review OR meta-analysis). In addition, three Korean traditional medicine journals (The Journal of the Korean Acupuncture and Moxibustion Society, The Journal of Korean Oriental Medicine and The Journal of Oriental Obstetrics and Gynaecology) were searched. The quality of the included studies was assessed using the Overview Quality Assessment Questionnaire.
ResultsOf the 55 potentially relevant studies that were found, 16 SRs were included in this report. These reviews evaluated the efficacy of acupuncture for treating the side effects of breast cancer chemotherapy, menstrual disturbances, menopausal symptoms, female infertility, uterine fibroids and polycystic ovary syndrome.
Conclusions Acupuncture was clearly beneficial in the management of chemotherapy-induced nausea and vomiting. In addition, current evidence suggests that acupuncture administered close to embryo transfer during in vitro fertilisation treatment improves the rates of pregnancy and live birth. In conclusion, there is no convincing evidence of the efficacy of acupuncture except for specific conditions, which include acupuncture administered with embryo transfer to improve the outcome of in vitro fertilisation and acupuncture for the management of chemotherapy-induced nausea and vomiting. More well-designed trials using rigorous methodology are required to evaluate the efficacy of acupuncture in treating gynaecologic conditions.

2.4. Ernst 2011

Ernst E, Lee MS, Choi TY. Acupuncture in obstetrics and gynecology: an overview of systematic reviews, American Journal of Chinese Medicine. 2011;39(3):423-31. [155620]

BackgroungAcupuncture is often recommended for obstetrical and gynecological conditions but the evidence is confusing.
Aim We aim to summarize all recent systematic reviews in this area.
MethodsWestern and Asian electronic databases were searched for systematic reviews of any type of acupuncture for any type of gynecological conditions. Our own files were hand-searched. Systematic reviews of any type of acupuncture for any type of gynecological conditions were included. Non-systematic reviews and systematic reviews published before 2004 were excluded. No language restrictions were applied. Data were extracted according to predefined criteria and analysed narratively.
ResultsTwenty-four systematic reviews were included. They relate to a wide range of gynecological conditions: hot flashes, conception, dysmenorrhea, premenstrual syndrome, nausea/vomiting, breech presentation, back pain during pregnancy, and procedural pain.
ConclusionsNine systematic reviews arrived with clearly positive conclusions; however, there were many contradictions and caveats. The evidence for acupuncture as a treatment of obstetrical and gynecological conditions remains limited.

3. Clinical Practice Guidelines

3.1. South Australia Health 2015 (SAH, Australia)

South Australian Perinatal Practice Guidelines. normal pregnancy, labour and puerperium management. Department of Health, Government of South Australia. 2015. [129633].

Offer Acupuncture and hypnosis where available in controlled settings