*Systematic Review* **Correction of Breech Presentation with Moxibustion and Acupuncture: A Systematic Review and Meta-Analysis**

**Jian-An Liao <sup>1</sup> , Shih-Chieh Shao 2,3,4, Chian-Ting Chang <sup>2</sup> , Pony Yee-Chee Chai <sup>2</sup> , Kok-Loon Owang <sup>2</sup> , Tse-Hung Huang <sup>1</sup> , Chung-Han Yang 4,5, Tsai-Jen Lee <sup>1</sup> and Yung-Chih Chen 4,6,\***


**Abstract:** Acupuncture-type interventions (such as moxibustion and acupuncture) at Bladder 67 (BL67, Zhiyin point) have been proposed to have positive effects on breech presentation. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of moxibustion and acupuncture in correcting breech presentation. We searched PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Electronic Periodical Services (CEPS), and databases at ClinicalTrials.gov to identify relevant randomized controlled trials (RCTs). In this study, sixteen RCTs involving 2555 participants were included. Compared to control, moxibustion significantly increased cephalic presentation at birth (RR = 1.39; 95% CI = 1.21–1.58). Moxibustion also seemed to elicit better clinical outcomes in the Asian population (RR = 1.42; 95% CI = 1.21–1.67) than in the non-Asian population (RR = 1.20; 95% CI = 1.01–1.43). The effects of acupuncture on correcting breech presentation after sensitivity analysis were inconsistent relative to control. The effect of moxibustion plus acupuncture was synergistic for correcting breech presentation (RR = 1.53; 95% CI = 1.26–1.86) in one RCT. Our findings suggest that moxibustion therapy has positive effects on correcting breech presentation, especially in the Asian population.

**Keywords:** breech; pregnancy; maternal and prenatal health; moxibustion; acupuncture; systematic review; meta-analysis
