**1. Introduction**

Breech presentation is a common malposition in the third trimester of pregnancy. The frequency of breech presentation in term pregnancies is 3%–4% in America and approximately 2% in China [1,2]. Risk factors for breech presentation include preterm labor, uterine anomaly, multiparity, placenta previa, and polyhydramnios [3]. Serious complications, such as traumatic injuries or asphyxia, can occur during vaginal delivery [4]. Therefore, a planned Caesarean section is recommended for pregnant women with breech presentation at childbirth [3]. However, Caesarean section is not free from complications, including wound infection, adhesions, hemorrhage, or scar rupture during subsequent labor [5]. Some non-invasive therapies are available, including knee-chest position management and

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**Citation:** Liao, J.-A.; Shao, S.-C.; Chang, C.-T.; Chai, P.Y.-C.; Owang, K.-L.; Huang, T.-H.; Yang, C.-H.; Lee, T.-J.; Chen, Y.-C. Correction of Breech Presentation with Moxibustion and Acupuncture: A Systematic Review and Meta-Analysis. *Healthcare* **2021**, *9*, 619. https://doi.org/10.3390/ healthcare9060619

Academic Editors: Manoj Sharma and Kavita Batra

Received: 12 April 2021 Accepted: 20 May 2021 Published: 22 May 2021

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external cephalic version (ECV). However, there is insufficient evidence to support kneechest position management, and ECV is a painful procedure for pregnant women [6,7].

Moxibustion and acupuncture have a long history in the treatment of various problems, including fetal malposition. The interventions are similar because they both stimulate acupoints to achieve a therapeutic effect. Moxibustion is a traditional Chinese procedure that utilizes the heat generated from a burning moxa stick (made from herbal preparations containing *Artemisia vulgaris*) to stimulate acupuncture points [8,9]. Several clinical trials have shown that moxibustion at Bladder 67 (BL67), also known as the Zhiyin point, elicits positive effects on breech presentation without serious adverse events [10,11]. However, systematic reviews and meta-analysis have reported conflicting results regarding the effects of moxibustion on breech presentation. For example, Vas et al. [12] and Li et al. [13] reported that moxibustion has positive effects on non-vertex presentation. However, Coyle et al. [14] suggested that moxibustion treatment may not improve non-cephalic presentations at birth relative to no treatment. To determine the efficacy of moxibustion on breech presentation, additional clinical trials since 2012 have investigated the effects of moxibustion [15,16]. Acupuncture has also been reported to correct fetal malposition, although evidence from systematic reviews and meta-analysis is lacking [17]. To fill this research gap, we conducted an updated systematic review and meta-analysis to evaluate the effects and safety of these acupuncture-type interventions in correcting breech presentation.
