Nine trials were included based on seven publications (total n=1,624). No publication bias was noted. Significant heterogeneity was reported overall (χ2 = 9.3, p=0.001; I2=96.2%) and a random effect model was used for the meta-analyses.
Seven RCTs (intervention n=421, control n=397) demonstrated a significant effect of acupuncture-type interventions to reduce breech presentation, OR 0.25 (95% CI: 0.11, 0.58). Two cohort studies (intervention n=347, control n=459) demonstrated similar results, OR 0.29 (95% CI: 0.19, 0.43).
Pooling both RCTs and cohort studies gave an overall OR 0.27 (95% CI: 0.15, 0.46) translating to 28 per cent breech presentation in the intervention group versus 56 per cent breech presentation in the expectant management control group.
No significant harmful effects were reported during or immediately after the intervention. Five cases of pre-term delivery due to pre-term premature rupture of the membrane were reported in the intervention groups across trials.