Papers by Marie-Julia Guittier
![Research paper thumbnail of [External cephalic version in case of persisting breech presentation at term: motivations and women's experience of the intervention]](https://a.academia-assets.com/images/blank-paper.jpg)
Gynécologie, obstétrique & fertilité
To evaluate the efficacy and acceptability of external cephalic version (ECV). From 2004 to 2008,... more To evaluate the efficacy and acceptability of external cephalic version (ECV). From 2004 to 2008, 212 pregnant women between 34-37 weeks of gestation with fetus in breech presentation were included in a randomized clinical trial and 125 externals cephalic versions were studied. A success rate of 37.6%t was recorded. At 34 weeks of gestation, 80.6% of women were considering an ECV in the event of persistent breech position at 37 weeks. These women expressed the desire to give birth vaginally (52% versus 24.4%, P<0.001). In contrast, others women preferred an elective cesarean section to avoid the risk of a breech vaginal delivery. Women felt pain during the ECV and scored 60 on average using the analogical visual scale. Women rated on a verbal rating scale the ECV as severely painful to unbearable (68%), and as stressful (70%). Despite this, the majority of women would recommend ECV to their friends or would be willing to repeat it for themselves. ECV remains a scary and painful m...
BMC pregnancy and childbirth, 2014
The birth of a first child is an important event in a woman's life. Delivery psychological im... more The birth of a first child is an important event in a woman's life. Delivery psychological impacts vary depending on whether delivery has been positively or negatively experienced. Delivery experience determinants have been identified but the understanding of their expression according to the mode of delivery is poorly documented. The purpose of the study was to determine important elements associated with women's first delivery experience according to the mode of delivery: vaginal or caesarean section. Qualitative approach using thematic content analysis of in-depth interviews conducted between 4 and 6 weeks' postpartum, in 24 primiparous women who delivered at Geneva University Hospital in 2012. Perceived control, emotions, and the first moments with the newborn are important elements for the experience of childbirth. Depending on the mode of delivery these are perceived differently, with a negative connotation in the case of caesarean section. Other elements influenci...
Gynécologie Obstétrique & Fertilité, 2012
Les variétés de présentations foetales occipito-postérieures représentent 10 à 34 % des présentat... more Les variétés de présentations foetales occipito-postérieures représentent 10 à 34 % des présentations céphaliques en début de travail. La majorité effectuera une rotation spontanée en mode occipito-antérieur au cours du travail mais 5 à 8 % persisteront en mode postérieur pour la phase expulsive de l'accouchement. Des observations ont montré que pour celles-ci, le risque de travail anormalement long, d'épuisement materno-foetal, d'accouchement instrumenté, de lésions périnéales graves et de césarienne, est augmenté. Le diagnostic de variété postérieure est souvent effectué tardivement, en fin de dilatation. Des recherches ont montré l'intérêt du diagnostic par échographie trans-abdominale au cours du travail. Quelques manoeuvres obstétricales, manuelles et instrumentales, ont été décrites pour tenter de corriger ces présentations dystociques à dilatation complète. Durant la phase de dilatation, l'attitude habituelle lors du diagnostic de variété postérieure est l'expectative. Des techniques posturales ont été décrites dans plusieurs ouvrages pour favoriser l'eutocie du travail. Une position maternelle destinée à faciliter la rotation foetale en mode antérieur durant la phase de dilatation a été décrite précisément par le Dr de Gasquet mais son efficacité n'a jamais été évaluée scientifiquement. Une revue Cochrane a montré que des postures similaires sont bien acceptées par les femmes et réduisent les douleurs lombaires. En revanche, la taille d'échantillon des études inclues semblait insuffisantes pour permettre une évaluation d'un intérêt pour les issues de l'accouchement, en général, et pour les issues défavorables associées aux variétés de présentation postérieures en particulier. Tenter de corriger ces malpositions foetales durant la phase de dilatation permettrait de réduire les issues défavorables au moment de la phase expulsive de l'accouchement. Des recherches sont nécessaires pour évaluer l'efficacité des positions maternelles pour corriger les variétés postérieures durant le travail. ß 2011 Elsevier Masson SAS. Tous droits réservés.
Journal of Maternal-Fetal and Neonatal Medicine, 2011
To assess whether changes in signal intensity of cervical stroma layers on magnetic resonance ima... more To assess whether changes in signal intensity of cervical stroma layers on magnetic resonance imaging (MRI) are associated with spontaneous preterm delivery. Prospective cohort study of women admitted for threatened late miscarriage or preterm delivery between 18 and 34 weeks of gestation. We performed T2-weighted low-field MRI of the uterine cervix among 100 women. Cervical stromal differentiation, defined as the contrast between signal intensities of the inner and outer cervical layers, was classified as high, intermediate, or low by a radiologist blinded to the participant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinical report. The main outcome measure was the proportion of spontaneous preterm delivery. Thirty-six women had a spontaneous preterm delivery. The proportion of spontaneous preterm delivery for high, intermediate, and low stromal differentiation was 7/24 (29%), 21/64 (33%; risk ratio 1.1; 95% confidence interval [CI]: 0.6-2.3), and 8/12 (67%; risk ratio 2.3; 95% CI: 1.1-4.8), respectively. The risk of delivering within 7 days increased when stromal differentiation decreased, although the difference was not statistically significant. The risk of spontaneous preterm delivery is increased in women with low cervical stromal differentiation on MRI. This risk is also associated with short cervical length, a measurement easier and less costly to obtain by transvaginal ultrasound.
Obstetrics & Gynecology, 2009
To estimate the efficacy of moxibustion between 34 and 38 weeks of gestation to facilitate the ce... more To estimate the efficacy of moxibustion between 34 and 38 weeks of gestation to facilitate the cephalic version of fetuses in breech presentation and the acceptability of this method by women.
Midwifery, 2011
Objective: to explore women's perceptions of their experience of the diagnosis of breech presenta... more Objective: to explore women's perceptions of their experience of the diagnosis of breech presentation and decision-making processes regarding the choice of mode of childbirth. Design: a qualitative study was conducted using semi-structured interviews. Data were analysed thematically. Setting: Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Switzerland. Participants: seven primiparous and five multiparous women experiencing a singleton breech presentation for childbirth were interviewed. Findings: two concomitant and interdependent processes were identified. First, an emotional response ranging from the hope that the fetus would return to a normal vertex position to the acceptance of breech presentation and its consequences. Second, a decision-making process related to childbirth mode for breech presentation with the complex management of intra-and extra-personal factor influences. Women perceive information about the risks of vaginal childbirth of paramount importance compared with those associated with caesarean childbirth. When women choose vaginal childbirth, influences related to their personality and life history appear to predominate. Women often have the feeling of being alone to assume the choice of childbirth mode and possible complications. Key conclusions: the diagnosis of breech presentation should not be treated as a commonplace event. The role of caregivers needs to go beyond information on the risks and benefits of both modes of childbirth. Emphasis should be placed on listening to the expectations of pregnant women for childbirth, creating spaces for dialogue, and allowing additional time for reflection. Useful information material should be provided to give the women a feeling of shared decision-making.
The Journal of Alternative and Complementary Medicine, 2013
To assess the effectiveness of hypnosis to reduce pain and facilitate external cephalic version (... more To assess the effectiveness of hypnosis to reduce pain and facilitate external cephalic version (ECV). Cohort study. Geneva University Hospitals, Switzerland. 63 women attempting ECV under hypnosis from 2010 to 2011 were compared with 122 women who received standard care from 2005 through 2008. Immediately after the ECV attempt, both groups completed the same questionnaire evaluating the participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; pain (visual analogue and verbal rating scales) and experience with the procedure. Physicians also completed a questionnaire that elicited their views on the effect of hypnosis on the intervention. A chi-squared test was used to compare differences in proportions, and the Mann-Whitney U test was used for differences in continuous variables. A thematic content analysis of the obstetricians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; responses to the open question regarding their experience of hypnotist accompaniment was also performed. Pain evaluated by women (visual analogue and verbal rating scales) and success rate of ECV. Pain intensity reported by women did not significantly differ between the hypnosis group and the standard care group (visual analogue scale score, 6.0 versus 6.3, respectively; p=.25; difference for verbal rating scale, p=0.31. In 72% of cases, physicians reported that hypnosis facilitated the procedure. The success rates in both groups were not significantly different (30% with hypnosis compared with 38% without; p=.31). Most women in both groups found the ECV attempt painful and a source of anxiety but would undergo it again if necessary. Hypnosis accompaniment during ECV does not reduce pain intensity associated with the procedure or improve the probability of a successful version.
The Journal of Alternative and Complementary Medicine, 2012
The aims of this study were to gain a better understanding of the motivations of pregnant women u... more The aims of this study were to gain a better understanding of the motivations of pregnant women utilizing moxibustion for breech presentation and to measure the impact of research results on these patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; treatment decisions regarding this alternative medicine technique. The study involved a statistical analysis of two self-administered questionnaires to 212 women who had previously participated in a randomized clinical trial on the efficacy of moxibustion; in addition, a qualitative thematic content analysis for open-ended questions was also performed. Most women (69%) reported treating themselves at least once with complementary and alternative medicine (CAM). Higher use of CAM was associated with higher education and Caucasian origin. Pregnancy was associated with a significant reduction in utilization of CAMs. After reading the results of a previous randomized clinical trial, which did not demonstrate efficacy of moxibustion, 60% of the women questioned expressed the intention of resorting to this technique in case of a subsequent pregnancy with a fetus in the breech position. The principal motivation was their desire to try anything that may possibly turn such fetuses to increase the chances of delivering them vaginally. It is important to consider the regard that pregnant women attribute to CAMs for self-care strategies. Despite a lack of scientific evidence supporting the use of moxibustion to address breech presentation, pregnant women consider CAMs, in general, to be safe and effective. Studies investigating the physical and psychologic effects of CAMs will enable clinicians to advise patients better about treatment options.
BMC Pregnancy and Childbirth, 2014
Background: The occipito-posterior (OP) fetal head position during the first stage of labour occu... more Background: The occipito-posterior (OP) fetal head position during the first stage of labour occurs in 10-34% of cephalic presentations. Most will spontaneous rotate in anterior position before delivery, but 5-8% of all births will persist in OP position for the third stage of labour. Previous observations have shown that this can lead to an increase of complications, such as an abnormally long labour, maternal and fetal exhaustion, instrumental delivery, severe perineal tears, and emergency caesarean section. Usual care in the case of diagnosis of OP position is an expectant management. However, maternal postural techniques have been reported to promote the anterior position of the fetal head for delivery. A Cochrane review reported that these maternal positions are well accepted by women and reduce back pain. However, the low sample size of included studies did not allow concluding on their efficacy on delivery outcomes, particularly those related to persistent OP position. Our objective is to evaluate the efficacy of maternal position in the management of OP position during the first stage of labour.
The Journal of Alternative and Complementary Medicine, 2008
Objectives: Moxibustion, a Traditional Chinese Medicine technique related to acupuncture, was pro... more Objectives: Moxibustion, a Traditional Chinese Medicine technique related to acupuncture, was proposed to facilitate cephalic version of breech presentation. Several trials were conducted to evaluate the efficacy, but there are few reports on the safety of moxibustion. Our objective was to assess the side-effects and acceptability of this intervention. Design: We are conducting a randomized controlled trial to evaluate the efficacy of moxibustion for breech version. The first 12 participants randomized in the moxibustion group had additional fetal surveillance by electronic monitoring. Subjects: Pregnant women with a fetus in breech presentation are included in the trial between 34 and 36 weeks of gestation. Interventions: We performed a cardiotocogram during 10 minutes before, 20 minutes during, and 10 minutes after each session. A maximum of 9 sessions were scheduled every other day, and stopped when cephalic version was diagnosed. The recordings were assessed by 3 independent readers using the Fischer scoring system. Outcome measures: Fetal well-being was evaluated by the cardiotocogram; effect on the mother was evaluated by blood pressure recorded before and after each session; maternal views, contractions, and perceived changes in fetal movements were assessed using a questionnaire. Results: A total of 65 cardiotocograms were analyzed. All scores were considered as normal, being at 8 or more on a 0-10 scale. Acceptability for the women and compliance to the intervention were good. No significant maternal or fetal side-effect was observed. Conclusions: We have not detected alterations of fetal and maternal well-being or other side-effects associated with moxibustion applied to the BL 67 for cephalic version of breech presentations. Moxibustion appears to be safe for both the mother and the fetus.
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Papers by Marie-Julia Guittier