QT interval changes in term pregnant women living at moderately high altitude.

OBJECTIVE: This study aimed to compare the QT interval changes in women with term pregnancy living at moderately high altitude (1890 m in Erzurum, Turkey) with those of women living at sea level (31 m in Istanbul, Turkey). MATERIALS AND METHODS: One-hundred ten women (n = 55, for each group) with full-term and single child pregnancies. Two different locations in that state were selected: Istanbul, Turkey, which is at 31 m above sea level (Group 1) and Erzurum, Turkey, at 1890 m above sea level (Group 2). Physicians from the two locations participated in the study. We estimated QTc, QTc Max, QTc Min, QT, and QTcd intervals. RESULTS: Moderately high altitude group had significantly longer QT parameters (QTc, QTc Max, QTc Min, QT, and QTcd intervals) compared with sea level group (P < 0.01, for all). CONCLUSIONS: According to our results, QT interval changes occur in term pregnant women living moderately high altitude. These changes may be associated with pregnancy-related cardiovascular complications in moderately high altitude.

Maternal and fetal Doppler velocimetry in women diagnosed with fear of childbirth.

AIM: This study aimed to investigate maternal and fetal Doppler flow parameters in term pregnant women diagnosed with fear of childbirth (FOC). MATERIALS AND METHODS: Women between 20 and 40 years with full-term singleton pregnancies (≥37 gestational weeks) were included in the study. All patients were questioned with Turkish form of Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A. Women with W-DEQ scores ≥85 were defined as FOC. Forty women diagnosed with FOC (FOC group) and 45 women with W-DEQ scores <85 (control group) underwent Doppler waveform analysis and the pulsatility index (PI) and resistance index (RI) values for uterine, umbilical, and mid cerebral arteries were recorded. RESULTS: Both groups had similar PI and RI values for umbilical and mid cerebral arteries (P > 0.05). However, PI and RI values for both right and left uterine arteries were higher in FOC group than control group (P < 0.05, for right uterine artery PI; P< 0.001, for left uterine artery RI; and P< 0.01, for others). CONCLUSION: It may be suggested that the presence of FOC in term pregnant women seems to have a negative effect on uterine blood flow parameters. When diagnosed with FOC, the women should be referred to a specialist for psychoeducation and psychosomatic support to decrease her fear and to minimize the negative impact of fear on the fetus.

The effect of colloid preload versus prophylactic ephedrine administration on QTc intervals during cesarean delivery: A randomized controlled study.

AIM: We aimed to investigate the effect of colloid infusion immediately before the spinal anesthesia, and the prophylactic intravenous (IV) infusion of ephedrine after injection of intrathecal bupivacaine on hemodynamic parameters, QT, The QT interval corrected for heart rate (QTc), and dispersion of QTc (QTcDisp) intervals in women undergoing the elective cesarean section. MATERIALS AND METHODS: Sixty women scheduled for elective cesarean delivery with spinal anesthesia were allocated randomly to receive either IV fluid preloading with 0.5 L of 6% w/v hydroxyethyl starch solution immediately before the spinal anesthesia (colloid group, n = 30) or prophylactic IV infusion of 15 mg ephedrine (diluted with 10 ml saline, n = 30) over 1-min period after the injection of intrathecal bupivacaine (ephedrine group). Electrocardiography (ECG) tracings were recorded before anesthesia procedure at baseline (T0), 5 min (T1), 10 min (T2), 30 min (T3), 60 min (T4), and 120 min (T5) after the spinal anesthesia. Systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) values were also recorded at the same time intervals. RESULTS: There were no significant differences between groups with respect to MAP, HR, SpO2, QT, and QTc intervals at any time points (P > 0.05). When compared with the colloid group, the QTcDisp interval at T1was significantly longer in the ephedrine group (P < 0.05). CONCLUSION: Both methods have similar effects on the ECG and hemodynamic parameters during cesarean section. So, both methods may be used in patients undergoing elective cesarean delivery under spinal anesthesia.

Umbilical cord blood endocan levels according to the delivery mode.

PURPOSE OF INVESTIGATION: The authors aimed to evaluate the endocan levels in the umbilical cord blood regarding the delivery mode. MATERIALS AND METHODS: One hundred six women aged between 20 to 35 years, undergoing delivery at term were studied. Three groups were formed; 37 neonates born by spontaneous vaginal delivery (group 1), 34 neonates born by an elective cesarean section with the general anesthesia (group 2), and 35 neonates, born by an elective cesarean section with spinal anesthesia (group 3). In delivery, umbilical cord blood samples were collected and endocan levels were measured. RESULTS: The endocan levels of cord blood (mean ± standard deviation, ng/ml) were found to be lower in group 2 (1.21 ± 0.46) compared to group 1 (1.52 ± 0.52) (p = 0.011). Cord blood endocan levels were not different in group 1 than those of group 3 (p = 0.49). CONCLUSION: It may be concluded that cord blood endocan levels are affected by the delivery mode.

Combining intrathecal bupivacaine and meperidine during caesarean section to prevent spinal anaesthesia-induced hypotension and other side-effects.

This study compared intrathecal hyperbaric bupivacaine with low-dose intrathecal plain bupivacaine plus different doses of meperidine (pethidine), administered sequentially, with regard to blood pressure stability, post-operative analgesia and incidence of side-effects in 80 parturients undergoing caesarean section. Patients were randomly assigned to one of four groups (n=20 each group): the HB group received 10 mg hyperbaric bupivacaine intrathecally; the BM35, BM30 and BM25 groups received 5 mg plain bupivacaine plus 35, 30 or 25 mg of meperidine intrathecally, respectively. The incidence of hypotension in the BM25 group was significantly lower than in the HB group. Nausea and vomiting were less prevalent in the BM25 group than in the HB and BM35 groups. In conclusion, sequential administration of 5 mg plain bupivacaine and 25 mg meperidine intrathecally provided better blood pressure stability and a lower incidence of side-effects than bupivacaine alone, without affecting quality of anaesthesia or surgical and patient satisfaction.