IntroductionMost hydrotherapy studies during childbirth report findings related to pain using a widespread set of subjective measures. In this study, ECG biomarkers as quantitative cardiac autonomic outcomes were used to assess the effects of warm shower hydrotherapy on laboring women during the first stage of labor.MethodsThis was a prospective single-blind cohort study on stage I delivering women. Their cardiac autonomic function was assessed using heart rate variability (HRV) measures during a deep breathing test using point-of-care testing comprised of an HRV scanner system with wireless ECG enabling real-time data analysis and visualization. Labor pain and anxiety were assessed using the Visual Analog Scale for Pain (VASP) and the Beck Anxiety Inventory (BAI). A total of 105 pregnant women in the first stage of labor who received warm shower hydrotherapy, intravenous analgesia (scopolamine + sodium dipyrone), or spinal anesthetic (bupivacaine + morphine) were enrolled.ResultsIn women during the first stage of labor, parasympathetic modulation reflected through RMSSD (root mean square of successive RR interval differences) was significantly reduced by hydrotherapy and intravenous analgesia (before vs. after mean rank diff. 35.73 and 65.93, respectively, p < 0.05). Overall HRV (SDNN, standard deviation of RR intervals) was significantly decreased only by intravenous analgesia (before vs. after mean rank diff. 65.43, p < 0.001). Mean heart rate was significantly increased by intravenous analgesia, while spinal anesthesia reduced it, and hydrotherapy did not alter it (before vs. after mean rank diff. –49.35*, 70.38*, –24.20NS, respectively, *p < 0.05, NS not significant).ConclusionThis study demonstrates that warm shower therapy may impact the sympathovagal balance via parasympathetic withdrawal in women during the initial stage of labor. The findings of this study provide quantitative support for using warm shower hydrotherapy during labor via point-of-care testing. The dependability of hydrotherapy as a non-pharmacological treatment is linked to the completion of more clinical research demonstrating quantitative evidence via outcome biomarkers to support indications on stress and birth progress.

Objective: Diabetic retinopathy (DR) is a major cause of vision loss, creating a low quality of life in patients. High blood pressure and serum insulin levels are known to be associated with DR. Though incident diabetic eye disease is reportedly related to systolic blood pressure (SBP), the potential importance of pulse pressure (PP) is not clear. The present study aimed at determining the association between pulse pressure, serum insulin levels and diabetic retinopathy in type 2 diabetes (T2DM) with or without systemic hypertension.Design and Method: Cross-sectional hospital-based study involving type 2 DM female patients with (n = 70) or without systemic hypertension (n = 36). The groups were matched for age, sex and BMI. Anthropometric measurements were taken, fasting blood glucose, glycated hemoglobin, serum insulin, and lipid profile were determined. Results:The mean values for weight and BMI were comparable between the groups, however, DBP, SBP, PP and serum insulin were significantly higher in the hypertensive diabetics. Using multiple regression (stepwise) analysis, there was a strong relationship between PP and DR in hypertensive diabetics (b = 2.239, p < 0.000, R2 = 0.143) while serum insulin showed a strong relationship with DR in patients with only T2DM (b = 2.190, p < 0.000, R2 = 0.253). Receiver operating characteristics (ROC) curve showed that PP with area under the curve (AUC) of 0.746 in hypertensive diabetics and serum insulin with AUC of 0.784 in patients with only T2DM were the most efficient predictors of DR respectively. Conclusions:The findings in the present study indicate that elevated PP and serum insulin could be reliable independent predictors of DR in T2DM female patients with or without systemic hypertension respectively.