Acupuncture before planned admission for induction of labor (ACUPUNT study): a randomized controlled trial

Abstract

Background: The increase in the use of induction of labor is a worldwide phenomenon in the current management of labor and delivery in Western societies, with approximately one out of every 4 pregnancies undergoing this procedure This has led women to seek various methods for stimulation of the onset of labor. Some data suggest that the use of acupuncture for favoring spontaneous labor onset could reduce the number of inductions of labor procedures. However, good quality evidence in this respect is not yet available.

Objective: The aim of this study was to evaluate the effectiveness of acupuncture using a filiform needle to induce spontaneous onset of labor in women with a scheduled induction of labor date and assess the safety and satisfaction of women undergoing acupuncture.

Study design: We conducted a multicenter, randomized, controlled, parallel-arm, unmasked trial in 3 hospitals in Spain. Eligible participants were women older than 18 years with a singleton pregnancy and a cephalic presentation, scheduled for induction of labor following center-specific protocols. Participants were randomly allocated to one of 2 groups: the intervention group, which underwent acupuncture sessions for a maximum of 4 days prior to the scheduled induction of labor, or the control group, which received no specific prelabor intervention. The primary study outcome was the proportion of women admitted because of spontaneous onset of labor or premature rupture of membranes before or the day of the scheduled induction of labor.

Results: Between November 2017 and June 2023, 212 women were recruited and included in the analysis (106 in the acupuncture group and 106 in the control group). There were no significant differences between the 2 groups in the baseline demographic characteristics. Regarding the primary outcome, 65.1% (69/106) of women in the acupuncture group and 39.6% (42/106) in the control group were admitted for spontaneous onset of labor or premature rupture of membranes (P<.001). Overall, women in the intervention group were admitted 1.25 days before (SD 1.4) their scheduled induction of labor date compared to 0.67 days (SD 1.15) for those in the control group (P=.001). The median time from recruitment to hospitalization was 4.48 days for the acupuncture group and 5.33 days for the control group (HR 0.52, 95% CI 0.35-0.77, P=.001). There were no significant differences between the 2 groups regarding the time from admission to delivery or the cesarean delivery rate. Nor were there differences in the rates of maternal or neonatal outcomes, and no maternal or fetal deaths occurred in either group.

Conclusion: Acupuncture with filiform needles, administered 4 days prior to scheduled induction of labor increased admission for spontaneous onset of labor and premature rupture of membranes before the induction of labor date.

Keywords: acupressure; acupuncture; induction of labor; maternal satisfaction; post-term pregnancy; prolonged pregnancy; spontaneous onset of labor.