Diagnostic Performance of First Trimester Screening of Preeclampsia Based on Uterine Artery Pulsatility Index and Maternal Risk Factors in Routine Clinical Use

Preeclampsia is a pregnancy-specific disorder defined by new onset of hypertension and proteinuria after 20 weeks of gestation. The early detection of patients at risk of developing preeclampsia is crucial, however, predictive models are still controversial. We aim to evaluate the diagnostic performance of a predictive algorithm in the first trimester of pregnancy, in order to identify patients that will subsequently develop preeclampsia, and to study the effect of aspirin on reducing the rate of this complication in patients classified as high risk by this algorithm. A retrospective cohort including 1132 patients attending prenatal care at Clínica Dávila in Santiago, Chile, was conceived. The risk of developing preeclampsia (early and late onset) was calculated using algorithms previously described by Plasencia et al. Patients classified as high risk, in the first trimester of pregnancy, by these algorithms, were candidates to receive 100 mg/daily aspirin as prophylaxis at the discretion of the attending physician. The overall incidence of preeclampsia in this cohort was 3.5% (40/1132), and the model for early onset preeclampsia prediction detected 33% of patients with early onset preeclampsia. Among the 105 patients considered at high risk of developing preeclampsia, 56 received aspirin and 49 patients did not. Among those who received aspirin, 12% (7/56) developed preeclampsia, which is equal to the rate of preeclampsia (12% (6/49)) of those who did not receive this medication. Therefore, the diagnostic performance of an algorithm combining uterine artery Doppler and maternal factors in the first trimester predicted only one third of patients that developed preeclampsia. Among those considered at high risk for developing the disease using this algorithm, aspirin did not change the incidence of preeclampsia, however, this could be due either to the small study sample size or the type of the study, a retrospective, non-interventional cohort study

Water, power and the production of neoliberalism in Chile, 1973-2005

Chile’s free-market economic and political reforms, designed and implemented under Pinochet’s military regime (1973-1990), have been important in discussions of neoliberal public policy and environmental governance. However, understandings of how and why these reforms unfolded often overlook the complex power dynamics involved. This paper examines the role of water in consolidating the design, implementation and outcomes of Chile’s neoliberal programme, through the contested production, retention and reform of the 1981 Water Code. Drawing on the idea that water and power are mutually constitutive, it demonstrates the significance of the transition to private tradable water rights with minimal state regulation not only for changing social relationships with water, but also for consolidating the neoliberal programme and the ambitions of the military regime, government technocrats and business conglomerates. I make three related arguments: first, that water was more central to the formation and effectiveness of the neoliberal programme in Chile, and the ambitions of its core supporters, than hitherto acknowledged; second, that political interest groups, and their alliances, can play crucial roles in neoliberalising nature; and, third, that water institutional reforms consolidate power relationships and produce waterscapes in particular ways