With great interest we read the article by Vas et al. This systematic review and metaanalysis exhaustively discusses 7 studies comparing moxibustion and other methods for correction of nonvertex presentation. The major conclusion is that with regard to the correction of nonvertex presentation, there is a beneficial effect of moxibustion applied at the acupuncture point BL 67.

However, this study has some limitations. The studies included in the review use a variety of control groups. The treatment in some of the control groups is only observational, so women in these groups get no treatment at all, while women in other control groups get interventions such as postural inducement of version and acupuncture on BL 67. Besides, the treatment groups in the studies included in the review also use a variety of treatments. Some of the treatment groups only get moxibustion, while other treatment groups get acupuncture or knee-to-chest posture next to moxibustion.

It would have been more justified if the 2 studies with observational control groups vs moxibustion alone in the treatment groups were separated from the other studies. From these other studies, it would be justified to separate the studies in which moxibustion plus knee-to-chest posture is compared to only knee-to-chest posture. In this way, the results of the moxibustion treatment would have been more interpretable for clinical use.

In March 2008, we published a systematic review of studies assessing the effectiveness of acupuncture-type interventions (moxibustion, acupuncture, or electroacupuncture) on acupuncture point BL 67 to correct breech presentation compared to expectant management, based on controlled trials. Several of the 9 studies reviewed overlap with those reviewed by Vas et al. Unfortunately, Vas et al were obviously unable to make a comparison with our review. By design we included only studies that used a control group without any intervention. We concluded that the current literature shows a beneficial effect of using acupuncture-type interventions on BL 67, including moxibustion, to induce correction of a breech presentation compared to expectant management.