Non cephalic presentation (NCP) in childbirth involves various risks to both the mother and the foetus. NCP includes breech, oblique and transverse presentations. The incidence of breech presentation (BP) is 20% at 28 weeks' gestation, although spontaneous version tends to occur more frequently , such that in only 3–4% of women with a full-term pregnancy is the foetus BP ; in Spain, NCP represents 3.8% of all births .
Until week 28–32, and under normal conditions, the foetus has a high degree of mobility, and remains in an unstable situation. From the latter date, the foetus adapts itself to the shape of the uterus, adopting a head-down posture, and normally remains so until birth. There are various reasons that may prevent the foetus from moving into the cephalic position, the most common of which, according to a specialized study  are: a) pre-term birth; this factor is more influential with lower gestational ages (35% before week 28, 16.8% from week 28–31, 8.9% from week 32–36 and 3.7% from week 36–41); b) foetal malformations (those most commonly related to NCP are anencephaly, hydrocephaly, spina bifida, polycystic kidneys and Potter's Syndrome, as well as trisomies 13, 18 and 21; c) multiple pregnancy, in which the incidence of NCP is 7 times greater than in the case of a singleton pregnancy. High levels of perinatal mortality and morbidity are known to be associated with NCP, due mainly to prematurity, congenital malformations, hypoxia or birth trauma [5, 6], and so a breech delivery is a birth that is categorized between dystocia and eutocia.
The most common technique used to end gestation in cases of NCP is that of caesarian section. From the results of the study by Hannah et al. , in October 2000, from the results produced by the Term Breech Trial Collaborative Group, and from the Cochrane Collaboration review , we now know that foetuses which are extracted by elective caesarian section have a lower level of perinatal morbi-mortality than those delivered vaginally. However, this technique does not prevent traumatic lesions to the foetal head and neck and, moreover, it is associated with an increase in maternal morbidity [8–11]. In addition to the increase in morbidity immediately following a caesarean section, there may occur other types of complications, such as intraabdominal adhesions, with the possibility of later infertility and risks in future pregnancies caused by the uterine scar .
Due to the risks arising both in breech presentation and from a caesarean section, various manoeuvres have been suggested over the years to promote spontaneous cephalic version of the foetus during the final two months of the pregnancy. Of these actions, the most commonly adopted is that of external cephalic version (ECV), which can be performed either between week 32–34 of gestation, or after week 37. A Cochrane Review concluded that, in comparison with the non-performance of ECV, the latter technique, when begun pre-term, reduces NCP births, while, in comparison with full-term ECV, beginning it between week 34–35 may be of some benefit as concerns the reduction of the rates of NCP and of caesarean section, although further trials were recommended . Other types of manoeuvres and techniques have been tested, with varying degrees of success, in order to increase foetal mobility in a non-traumatic way.
Acupuncture and moxibustion are therapeutic techniques found in traditional Chinese medicine. They have been employed since ancient times, and specific recommendations in Chinese texts include the application of heat (moxibustion) by the combustion of Artemisia vulgaris (moxa) over an acupuncture point in order to correct NCP [12, 13]. This latter point, known as Zhiyin (BL67) is located in the outer corner of the little toenail. In addition to moxibustion, acupuncture may also be used, either alone or in association with moxibustion, on this or other points, although it has been found that the highest level of effectiveness is associated with the application of moxibustion alone . A Cochrane review  concluded that there is insufficient evidence from the studies included in its analysis, and observed that there have been few well-designed studies (only 3 are included in the review) and that most of them used a small sample. Some studies with a larger sample, such as that by Kanakura et al. , were not randomized. A larger, systematic review that we have carried out this year (manuscript submitted for publication), with the inclusion of new studies performed to date, and with the incorporation of those published in Chinese in the last 10 years, shows that studies contain to be of low methodological quality. We estimate a correction rate of 70% (versus 50% in control groups) among pregnant women treated with moxibustion. Among the studies carried out so far, no reports have been made of side effects, although the smoke generated while the moxa is burned may irritate the respiratory tracts. Nevertheless, there is no evidence to support this hypothesis . Neri et al. [14, 17] have made a cardiotocographic study of the effects of moxibustion on foetal heartbeat, and concluded that no harm is caused by this process.
The present study is funded by the Health Ministry of the Andalusian Regional Government (Project No. 0053/2007).