Acupuncture Treatment for Threatened Abortion

Abstract

Background:

Threatened abortion, also known as threatened miscarriage, is a common complication in pregnant women; it seriously harms their physical and mental health. However, there are only a few reports on acupuncture treatment to address threatened abortion.

Case:

A woman had a threatened abortion. She experienced vaginal bleeding and had an intrauterine hematoma after embryo transfer. She declined medication use because of concerns about the adverse effects to the embryo. Therefore, acupuncture treatment was performed to relieve her pain and save the fetus.

Results:

After the 4th treatment, her vaginal bleeding stopped, and her uterine effusion was reduced to 27 × 22 mm. After the 11th treatment, the uterine effusion decreased even more—to 40 × 7 mm—and disappeared completely after the 16th treatment. No adverse events occurred during her treatment, and her bleeding and uterine effusion did not recur. The fetus developed normally, and the child was born. This child is currently healthy and growing.

Conclusions:

By stimulating the body's acupoints, acupuncture can be used to adjust the Qi and Blood, and consolidate Extraordinary Vessels, mainly in Chong and Ren, to prevent miscarriage. This case report provided information about the treatment of a threatened abortion and illustrated how acupuncture was be used to stop a threatened abortion. This report can be utilized to support high-quality randomized controlled trials. Given that there is a lack of standardized and safe procedures for treating threatened abortion by using acupuncture, this research is needed.

INTRODUCTION

Threatened abortion is a type of spontaneous abortion.¹ It is diagnosed based on vaginal bleeding when the cervix is closed, a positive urine pregnancy test, and their being no evidence of fetal or embryo death within 20 weeks of pregnancy.² About one-fifth of pregnant women will have threatened abortion, and women with threatened abortion are 2.5 times more likely to have a miscarriage than healthy women.³ Studies have shown that ∼50% of patients with threatened abortion will develop miscarriages, and are more prone to adverse consequences in the later stages of pregnancy.⁴ However, there are only a few reports on using acupuncture treatment for threatened abortion. Herein, this article describes a case of a woman with threatened abortion after embryo transfer (ET), who recovered and gave birth successfully after 21 acupuncture treatments.

CASE

A 34-year-old female patient presented on August 7, 2019, with vaginal bleeding and uterine effusion for 20 days after ET. She had undergone ET on July 18, 2019. After the procedure, this patient developed vaginal bleeding and felt dispirited, fatigued, and weakness in her limbs. Gynecologic B-ultrasound (US) examination revealed an irregular hypoechoic sac area of 56 × 17 mm between the gestational sac and the posterior wall of the uterine fundus. There were no obvious abnormal signs of the fetus or bilateral appendages. The patient visited the First Affiliated Hospital of Kunming Medical University and First People's Hospital of Kunming City. Both hospitals offered 2 options: (1) hemostatic injection and (2) continued observation for natural absorption. Because the patient was worried that the medicine would affect the fetus, she immediately declined the drug treatment and sought acupuncture treatment.

After obtaining informed consent from the patient, traditional acupuncture treatment was performed. The following traditional acupoints were chosen for the treatment as fixed points (Table 1): GB 20; ST 36; ST 37; ST 41; KI 3; LR 3; and SP 1. At the same time, the following 4 groups of acupoints were selected as non-fixed points: (1) SP 4 and PC 6: (2) GB 41 and TE 5; (3) SI 3 and BL 62; and (4) LU 7 and KI 6. Depending on the time of the patient's visit, Zi Wu Ling Gui software, developed by Cheng-Ta Hsieh, was used to determine which groups of acupoints to select. A simple calculation method of Zi Wu Ling Gui for selecting group acupoints according to the time of each visit was also provided. All acupoints were localized according to the 2010 World Health Organisation's Standard Acupuncture Point Locations.⁵

Table 1.

Locations of Acupoints

Acupoints	Locations
GB 20 (Fengchi)	In the anterior region of the neck, inferior to the occipital bone, in the depression between the origins of sternocleidomastoid & the trapezius muscles
ST 36 (Zusanli)	3 cun below Tupi, 1 finger breadth from the anterior crest of the tibia
ST 37 (Shangjuxu)	6 cun below Tupi, 1 finger breadth from the anterior crest of the tibia
ST 41 (Jiexi)	Over the dorsum of the foot, right in the center of the cruriate crural ligament, between the tendons of the extensor hallucis longus & the extensor digitorum longus
KI 3 (Taixi)	In the depression between the tip of medial malleolus & tendo calcaneus
LR 3 (Taichong)	On the depression distal to junction of the first & second metatarsal bones
SP 1 (Yinbai)	∼ 0.1 cun behind the corner of the vallum unguis at the medial side of the big toe
SP 4 (Gongsun)	1 cun behind the proximal end of the proximal phalange on the medial aspect of the foot, anteroinferior to the base of the first metatarsal bone, at the border between the red & white flesh
PC 6 (Neiguan)	2 cun above Taling in between the 2 tendons of the palmaris longus muscle & flexor carpi radialis muscle
GB 41 (Zulinqi)	fourth & fifth metatarsal bones, in the depression lateral to the fifth extensor digitorum longus tendon
SJ 5 (Waiguan)	2 cun proximal to the dorsal wrist crease, midpoint of the interosseous space between the ulnar & radius
SI 3 (Houxi)	On the ulnar side proximal to the metacarpophalangeal joint of the little finger; point is located at the end of the transverse crease of the palm, lying on the red & white skin, when the fist is clenched slightly
BL 62 (Shenmai)	On the lateral aspect of the foot, directly inferior to the prominence of the lateral malleolus, in the depression between the inferior border of the lateral malleolus & the calcaneus
LU 7 (Lieque)	1.5 cun above the most distal transverse crease of the wrist, above the styloid process of the radius
KI 6 (Zhaohai)	In the depression directly below the medial malleolus

The needles used were domestic 0.25 mm × 25–mm disposable acupuncture needles (Tianjin Yipeng Medical Instrument Co., Ltd.). The patient was placed in a Fowler's position, and the practitioner actively communicated with her before treatment to eliminate her tension and fear. The practitioner inserted the needles directly into the points, without manipulation. After completing all points, the patient was instructed to close her eyes, relax her limbs, and maintain the needles in place for 40 minutes. This treatment was performed every alternate day for a total of 21 acupuncture treatments.

RESULTS

Gynecologic B-US was used to evaluate the therapeutic effects. After her 4th treatment, her vaginal bleeding stopped, and her uterine effusion was reduced to 27 × 22 mm. After the 11th treatment, her uterine effusion decreased to 40 × 7 mm. After the 16th treatment, her uterine effusion disappeared completely (Fig. 1 and Table 2). There were no adverse events during the entire treatment course, including no recurrence of bleeding symptoms and no uterine effusion. Her fetus developed normally during her follow-up. The child was born, and, as of this writing, is healthy and growing up.

FIG. 1.

Changes in symptoms shown on B-ultrasound before and after acupuncture.

Table 2.

Changes in Vaginal Bleeding and Intrauterine Hematoma Before and After Acupuncture

	Before treatment	4th treatment	11th treatment	16th treatment
Vaginal bleeding	√	×	×	×
Intrauterine hematoma	56 × 17mm	27 × 22mm	40 × 7 mm	Completely disappeared

√, present; ×, not present.

Written informed consent was obtained from a legally authorized representative for anonymized patient information to be published in this article. The datasets for this case can be obtained from the corresponding author according to reasonable requirements.

DISCUSSION

Threatened abortion refers to vaginal bleeding that occurs during pregnancy when the cervix is closed and the fetal heartbeat is normal. It is one of the most common complications of pregnancy and can have a serious impact on women's physical and mental health. Some scholars believe that the occurrence of threatened abortion is mostly related to pregnancy hormone levels.⁶ According to the theory of Traditional Chinese Medicine, this disease is caused by impaired Chong and Ren channels, which cause miscarriage. Acupuncture can be used to adjust the Qi and Blood and consolidate Extraordinary Vessels, mainly in Chong and Ren, to prevent miscarriage by stimulating the body's acupoints. Although the biologic mechanism of acupuncture for treating threatened abortion is not clear, related studies have shown that acupuncture can regulate the intrauterine environment, and affect serum estradiol, progesterone, and other related hormones, thereby adjusting the endocrine system to be beneficial for the embryo. ^7,8 There is also a study showing that acupuncture can treat irregular uterine bleeding effectively, but modern research on acupuncture's mechanism and efficacy remains scarce.⁹ In addition, a study also showed that acupuncture can inhibit expression of interleukin-1β to inhibit inflammatory factors, thereby promoting reabsorption of effusions.¹⁰

With the growing interest in acupuncture treatment by pregnant women,^11,12 it may be a feasible alternative treatment for diseases in pregnancy.¹³ A pilot randomized controlled trial (RCT) involving 40 women found that acupuncture reduced threatened abortion significantly, including bleeding, cramping, and back pain, compared to a touch intervention.¹⁴ The potential for acupuncture as a treatment for threatened abortion has been suggested for early pregnancy,¹³ and many acupuncturists believe that acupuncture can be used to treat threatened miscarriage,¹⁵ but there are no trials yet to verify the safety or use of this treatment.

CONCLUSIONS

In this case, the patient's vaginal bleeding symptoms disappeared completely, and the uterine effusion decreased gradually until it disappeared after acupuncture treatment. This case report provides information about the treatment of threatened abortion and illustrates how acupuncture can be used to address threatened abortion. The current authors believe that it is necessary to accumulate more cases in the future. An RCT with a large sample size is needed to verify the clinical effectiveness of acupuncture for treating threatened abortion. In addition, the acupoints selected in this case were not contraindicated in the traditional theory of acupuncture treatment for pregnant women, and it was performed by a practitioner with 12 years of clinical experience. The practitioner had clinical experience with regard to not performing any manipulation and duration of needle retention. There is a lack of standardized and safe operations for treating threatened abortion using acupuncture, and further research is required.¹⁵

AUTHORs' CONTRIBUTIONS

Drs. Guo and Li provided the case and performed the acupuncture; they discussed treatment options with Drs. Zhang and Zhao. All 4 clinicians followed up with the patient. Dr. Feng and Li drafted and edited the article. All of the authors read and approved the final version of the article.

ACKNOWLEDGMENTS

The authors thank the subject of this case report, who gave her written informed consent to publish this article about her case.

AUTHOR DISCLOSURE STATEMENT

No financial conflicts of interest exist.

FUNDING INFORMATION

The work was supported by the Top-notch Young Talent Project of Yunnan Ten Thousand Talents (YNWR-QNBJ-2019-257) and the Yunnan Province Professional Degree Graduate Case Library Construction Project of the Teaching Case Library Classical Selection of Acupuncture, Moxibustion and Massage (Yun degree 18-173 [2021]). The funding agencies did not play any role in the design, collection, analysis, or writing this article.