Cities around the world are struggling to access additional water supplies to support their continued growth because their freshwater sources are becoming exhausted. Half of all cities with populations greater than 100,000 are located in water-scarce basins, and in these basins agricultural water consumption accounts for more than 90% of all freshwater depletions. In this paper we review the water development histories of four major cities: Adelaide, Phoenix, San Antonio and San Diego. We identify a similar pattern of water development in these cities, which begins with the exhaustion of local surface and groundwater supplies, continues with importation of water from other basins, and then turns to recycling of wastewater or stormwater, or desalination of either seawater or brackish groundwater. Demand management through water conservation has mitigated, to varying degrees, the timing of water-system expansions and the extent to which cities rely on new sources of supply. This typical water development pattern in cities is undesirable from a sustainability perspective, as it is usually associated with serious ecological and social impacts as well as sub-optimal cost effectiveness. We highlight case examples and opportunities to invest in water conservation measures, particularly through urban-rural partnerships under which cities work with farmers to implement irrigation conservation measures, thereby freeing up water for ecological restoration and use by cities.

In a series of 2434 patients with pre-eclampsia, the prevalence of fetal growth retardation was 8.7 per cent compared with 8.6 per cent in the total hospital population. The prevalence was increased in early-onset pre-eclampsia (18.2 per cent) (P <0.001) and reduced in late-onset pre-eclampsia (5.6 per cent) (P <0.001). In patients who later developed early-onset pre-eclampsia with fetal growth retardation, the prevalence of subnormal oestriol excretion was significantly increased (79.5 per cent) (P

This study reports the fetal outcome in 500 pregnancies when the baby weighed less than the 10th centile for gestational age at birth, compared with that in a series of 500 pregnancies where there was a normal weight for gestation. Fetal growth retardation (0-9th centile) had a significant positive association with perinatal mortality (5.2% versus 1.2%, P greater than 0.001) and low oestriol excretion (42.4% versus 15%, P greater than 0.001), but not with major fetal malformations or fetal asphyxia. In the study group, 20 of the 26 perinatal deaths were associated with subnormal oestriol excretion. When severe fetal growth retardation was considered (less than the 5th centile), the associations with perinatal mortality (19%) and subnormal oestriol excretion (63%) were stronger and a significant correlation with major malformations emerged (17%, P greater than 0.001). Detection of subnormal oestriol excretion allows identification and appropriate treatment of severe fetal growth retardation which should improve survival and neurological development in these infants. This study confirms that birth-weight below the 10th centile is an appropriate definition of fetal growth retardation in terms of perinatal mortality and morbidity.