Oxygen saturation as a predictor of adverse maternal outcomes in women with preeclampsia.

OBJECTIVE: We sought to determine the role of respiratory assessment by cardiorespiratory symptoms and/or oxygen saturation by pulse oximetry (SpO2) in predicting adverse maternal outcomes in women admitted to hospital with preeclampsia. METHODS: These data derive from an international, prospective multicentre cohort study, PIERS (Pre-eclampsia Integrated Estimate of RiSk), which assesses predictors of adverse outcomes in women admitted to tertiary perinatal units with preeclampsia. Univariate and multivariate analyses of cardiorespiratory symptoms and pulse oximetry were performed to assess their ability to predict a combined adverse maternal outcome developed through international Delphi consensus. RESULTS: SpO2 successfully predicted adverse maternal outcomes; the area under the receiver-operator characteristic curve (AUC ROC) was 0.71 (95% CI 0.65 to 0.77). Combining the symptoms of chest pain and/or dyspnea with pulse oximetry improved this predictive ability (AUC ROC 0.73; 95% CI 0.67 to 0.78). When SpO2 was stratified into risk groups using inflection points on the ROC curve, the highest risk group (SpO2 90% to 93%) had an odds ratio of 18.1 (95% CI 8.2 to 40.2) for all outcomes within 48 hours when compared with the baseline group (SpO2 98% to 100%). CONCLUSION: Assessing SpO2 aids in the assessment of maternal risk in women admitted to hospital with preeclampsia. An SpO2 value of ≤ 93% confers particular risk. The symptom complex of chest pain and/or dyspnea adds to the association

Environment, economy and society: fitting them together into sustainable development

Sustainable development is a contested concept, with theories shaped by people's and organizations' different worldviews, which in turn influence how issues are formulated and actions proposed. It is usually presented as the intersection between environment, society and economy, which are conceived of as separate although connected entities. We would argue that these are not unified entities: rather they are fractured and multi-layered and can be considered at different spatial levels. The economy is often given priority in policies and the environment is viewed as apart from humans. They are interconnected, with the economy dependent on society and the environment while human existence and society are dependent on, and within the environment. The separation of environment, society and economy often leads to a narrow techno-scientific approach, while issues to do with society that are most likely to challenge the present socio-economic structure are often marginalized, in particular the sustainability of communities and the maintenance of cultural diversity. Copyright © 2002 John Wiley & Sons, Ltd. and ERP Environment