Menace d'accouchement prématuré. Bouschbacher JM 2000

Date: 2000
Auteurs: Bouschbacher JM, Dalbin G, Levesque J, Mangeot J, Mayer Y.
Titre: The  contribution of acupuncture in the treatment of premature labor.  Pan Pacific Medical Acupuncture Conference. October 25-28th October, Las Vegas. Nevada, USA
Mots clés: Premature labor, preterm labor, prématuré, menace d'accouchement prématuré, MAP, Kid-9, Zhu Bin, RN-9, Co-3, VC-3, Zhong Ji, CV-3
Contribution: congres
Abstract: Premature labor is by definition any labor occurring prior to 37 weeks of amenorrhea. Threatened premature labor (TPL) consists of the occurence of uterine contractions with cervical alterations. TPL is an important part of the obstetrical pathology as it is responsible for a large number of hospitalisations, sick leave, death and perinatal after-effects. Furthermore, the drugs used in Western medicine (betamimetics, anti-prostaglandins, nitric derivatives????, magnesium sulfates) are not without side-effects on the mother and the fetus.
In Traditional Chinese Medicine (T.C.M.) TPL is referred to as "restless fetus". Hence the treatment will aim at calming down the fetus. We shall consider two questions:
The treatment of side-effects associated with tocolysis. In the treatment of TPL, we can use symptomatic points or work according to clinical patterns.
The symptomatic points for TLP are Kid-9 (Zhu Bin) and Ren-3 (Zhong Ji)
While quoting the Da Cheng Soulié de Morant (8) prescribes Zhu Bin to prevent miscarriages. A survey of TPL by Romano et al (6) has shown that better results were achieved with the treatment of TPL by this point than those obtained by tocolysis with betamimetics only. It is interesting to notice that this point is also very effective (4) to treat painful pelvic-abdominal syndromes of the pregnant woman. (These syndromes perfectly mimic TPL).
Zhong Ji is the meeting point of the Yin meridians of the lower limb and the Conception Vessel. Rempp (5) uses it successfully by needling it upwards with a long needle.
Treatment according to clinical patterns: six patterns can be described:
Deficiency of Liver Blood
The fetus which does not receive sufficient nourishment will be agitated. Clinically, this pattern brings to mind TPL associated with fetal growth retardation. The proposed treatment will consist of: Zu San Li (ST-36), Tai Chong (Liv-3), Qu Quan (Liv-8)
Spleen Qi Deficiency
The intensity of the cervical modification contrasts with the low level of uterine contractions. Pi Shu (Bl-20) and Zu San Li (ST-36) will be used.
Liver Qi Stagnation
Uterine contractions are stronger. This pattern can be found in the pathology of stress but also in the case of overdistension of the uterus hindering the free circulation of Qi in the abdomen (multiple pregnancies, hydramnios, fetal overgrowth...) Nei Guan (Per-6) and Qi Men (Liv-14) can help solve the problem.
Kidney and Spleen Yang Deficiency
In this pattern, dampness and oedema prevail. Cold penetrates the womb and provokes pain. The weakened Yang cannot retain the liquids; everything tends to prolapse (organs, fetus, amniotic sac). Cold requires the use of moxas in particular on the pelvic points (Zhong Ji Ren-3, Qi Hai Ren-6...)
Kidney Jing Deficiency
The Jing controls reproduction, development, growth. Thus, this diagnosis ought to be considered in cases of growth retardation. Previous history of the mother (age, sterility, uterine and/or vaginal malformation) and possible fetal abnormalities should be investigated as well. The points of reinforcement of the Kidney will be used to strengthen the Jing (Shen Shu Bl-23, Zhi Shi Bl-52, Ming Men GV-4, Qi Hai Ren-6, Guan Yuan Ren-4)
Kidney and Liver Yin Deficiency
Although there are contractions, they are not very effective (contractile uterus). Tinnitus, dizziness, headaches could be indicative of high blood pressure. According to our experience (2), a sudden loss of sleep during pregnancy is forewarning of pregnancy toxaemia. Zhao Hai (Kid-6) associated with Tai Chong (Liv-3) or Xing Jiang (Liv-2) help nourish Kidney and Liver Yin.
Treatment of Western tocolysis side-effects: Our experience relates mainly to the use of betamimetics. These drugs provoke a clinical syndrome very similar to the pattern of Heart and Kidney Yin Deficiency (tachycardia, palpitations, mood swings, sleep disorders, flushing, afternoon fever, night sweats, tremor, insomnia). We advise the use of Zhu Bin (Kid-9) for its action both on TPL and on the effects of the tocolysis. We also suggest the point Xi Men (Per-4). We believe that an identical reasoning should be used for other medications.
In conclusion:
Acupuncture is utmostly appropriate to treat TPL, it enables the reduction of dosages of tocolytic drugs, lessening their side-effects, it even gains extra time for the child to be born. Besides, it is worth acknowledging the use in this situation of a certain number of points traditionnally contraindicated during pregnancy.

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