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Acupressure Healing Meditations. Learn 15 fully guided meditations with Acupressure points to find peace of mind and enhance your journey to spiritual awakening. The points open the flow of healing energy to greater enhance your meditation practice and experience. Abdullah Al Mamun. Veda Thakkar. Ajeet Sharma. Ana Jacinta. Thilina Danushka. Akshay Ramade. Tina Ttaboo. Jinnah Gandhi.
Ravikumarrd Ravi. Liz Zach. Anirudh Modi. Akbar Ali. Thaddeus Moore. More From pinoybsn Recruitment Selection Process Methods and Steps 9. Anonymous 5mSMeP2j. Popular in Medicine. Bob Andrepont. Lianne Kaye Apasao. Homeopathy Torrents. Bernice Joy Calacsan Daguna. Anonymous ic2CDkF. Abebe Setiye. Therefore, this RCT is not perceived as of sufficient rigor to base future treatment recommenda- tions.
Prior EA use, high risk pregnancy, and pacemaker use were pre-randomization exclusion crite- ria. Post-randomization, inevitable cesarean delivery or precipitous labor led to partic- ipant exclusion. Pain was measured by a 10 cm VAS. Demographically, the three groups were homogenous. In comparison to standard antepartum care, EA at Jiajin TLL3 also resulted in greater reduction in mean Stage 1 active labor length Across groups there was not statistical difference in duration of stage 2 and 3 labor, augmentation use, neo-natal weight, or APGAR scores.
Post-randomization exclusion criteria based analysis instead of intent to treat analy- sis is a study limitation [23]. Small group sizes were used [23]. Acupuncture at Hegu LI4 From September to December , women at 37 or greater weeks estimated gesta- tional age at a public teaching hospital in Iran underwent stratified randomization in blocks of 2, to bilateral acupressure at Hegu LI4 or bilateral light touch at Hegu LI4 , 50 participants per group [30]. Substance abuse, three previous deliveries, prior CD, complicated obstetric history, and receipt of analgesic or augmentation in the current labor before study participation at 3 to 4 cm dilation were the main exclusion criteria.
Five 3 to 5 kg pressures per minute for 20 minutes formed the intervention. Numerous point VAS measurements were taken [30]. Nwanodi Demographically, the groups were identical. Therefore, shortened labor duration in this RCT may not be attributable to the acupressure intervention, which is a study li- mitation.
Acupuncture at Sanyinjiao SP6 From January to August , women at 37 weeks estimated gestational age at a public teaching hospital in Sao Paulo state, Brazil, participated in a double-blind RCT of 20 minutes bilateral Sanyinjiao SP6 point acupressure and bilateral SP6 acupoint touch placebo TG during contractions, with an un-blinded control group [21].
Ran- domization of 52 participants per group was by random number list. There were nei- ther age nor parity exclusions. Women at 4 cm or more dilation with 2 to 3 contrac- tions in 10 minutes without contraindication for bilateral SP6 point acupressure were included. High risk pregnancies, including women with two or more previous CD were excluded [21].
Brisk and rapid decompression medium-intensity 5 to 15 kg acupres- sure was performed with the index finger. Very-low-intensity pressure g was per- formed for the TG. This study was designed to assess labor duration and cesarean sec- tion rate. This study was included as the longer a patient labors, the longer she is in pain. Compared to control, bilateral Sanyinjiao SP6 acupoint acupressure reduced average labor duration by Therefore, it reduced average labor duration in the intervention group cannot be attributed to the intervention, bilateral Sanyinjiao SP6 acupoint acupressure.
Due to painful stimulation use, the Bonapace and Marchand Classification cate- gorizes acupuncture, acupressure in the diffuse noxious inhibitory control theoretical model DNIC. However, this meta-analysis is limited by the inclusion of a fair quality, poten- tially biased, RCT of high intensity TENS, and a fair quality, low risk of bias, RCT of sterile water injections in the analysis of acupuncture, acupressure, and electro- acupuncture RCT, in the only presented DNIC category analyses [31].
When noninva- sive EA is performed with TENS, smaller electrodes positioned at acupoints are used, whereas for TENS larger electrodes are used, which are not necessarily placed at acu- points [56]. Similarly, sterile water placement may or may not occur at acupoints [56]. The resultant statistical analyses showing increased epidural use, increased labor pain, and decreased maternal satisfaction with childbirth, in usual care participants when compared to NPLPM participants, cannot be directly compared to an OR from a meta- analysis restricted to acupuncture, acupressure, and electro-acupuncture.
This meta- analysis may have achieved greater significance if the DNIC category analysis had been performed on a sub-group and a group level [31]. Critical Narrative Review of Systematic Reviews Reference [22] reviewed four systematic reviews from to , incorporating 16 original trials, and 5, unique participants. Six of the eight RCT reviewed in reference [31] are included [22]. The critical narrative is limited by inconsistencies between the text and the tables, especially, participant numbers [22].
Heterogeneity in the outcomes analyses for each of the four incorporated systematic reviews, means that despite duplication of included original trials, the resultant outcomes data may not be directly comparable. However, use of the acupoint Sanyinjiao SP6 was associated with increased uterine contractility, consistent with physiologic mechanism of action by stimulating pituitary gland oxyto- cin release [22]. Hegu LI4 acupoint use was also associated with lower pain intensity scores, consistent with physiologic mechanism of action by stimulating endorphin re- lease [22].
Second stage epidural discontinu- ation impairs labor analgesia without removing the increased operative vaginal delivery risk [1]. However, for near-term and term induced nulliparas, epidural analgesia does not increase labor duration or cesarean delivery rate [1]. Unlike acupuncture, EA, and acupressure that are recommended for first stage of labor use, epidural analgesia can be used in both the first and second stages of labor [1].
Hypovolemia, local anesthetic al- lergy, injection site skin infection, and coagulopathy are contraindications to epidural analgesia [1]. Epidural analgesia may cause hypotension, lumbago, fever, post dural puncture spinal headache, nerve injury, and paralysis [1].
Discussion Single performance of bilateral MA at Hegu LI4 and Zu san li ST 36 for 20 to 30 minutes can significantly reduce duration of labor from 4 cm dilation by 68 minutes [25]. Future research should display study design consistency, facilitating comparison across RCTs, which is currently problematic [22].
Instead of multiple pain scales an ungraded mm pain line, the McGill 10 cm pain ruler, a point VAS, and 0 to VAS , a single pain scale should be used [2] [25] [26] [27].
Membrane status should be uniformly reported across all future RCT. The RCT described above used different set points for onset of active phase labor, which makes comparison of duration of active phase labor difficult.
Although this inconsistency is consistent with the literature, for research purposes a single set point for the onset of active phase Stage 1 labor is needed [19] [57]. Use of different EA devices, and different settings on the EA devices, limits direct compari- son across studies.
Future RCT could also improve upon the literature. Group and sub-group size could be increased to a minimum of 60 participants [23].
Given the current global trend to- wards obesity, RCT should include overweight and obese patients. Computer-generated randomization with allocation concealment is preferable to the use of intervention as- signment containing envelopes [55]. Nwanodi TCM, to facilitate reproducible RCT, reproducible dosing regimes with a limited num- ber of acupoints and a fixed dosing pattern are needed.
Post-randomization participant exclusion reduces the level of evidence. Intent to treat analysis is preferable. Several areas of future research are clear. EA device and setting equivalence studies would limit the need to use identical EA devices in future studies, providing investiga- tor and facility flexibility. Additional RCT of acupressure at Sanyinjiao SP6 to support or refute reference [21], and add analgesia data to complement labor duration data are needed.
As none of the included RCT ex- pressly included participants with current or remote substance abuse, future RCT should consider including participants with a history of substance abuse to evaluate comparative efficacy of acupuncture and acupressure for all patient populations.
Future studies could consider combining acupuncture or acupressure with regional analgesia to evaluate if the labor shortening effects of acupuncture and acupressure balance the labor prolonging effects of regional analgesia. More studies on acceptability of the available array of NPLPM modalities could better describe interest, while also inform- ing health care providers and facilities as to what to offer pregnant women.
Due to demographic and physiologic disparities between the intervention and con- trol groups, bilateral acupressure at Sanyinjiao SP6 cannot be recommended without corroborating studies [21]. Adobe PDF format allows you to view the document electronically and print it out on any printer. If you do not already have a copy of the Acrobat Reader you follow this link to download and install a copy suitable for your computer from the Adobe site.
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