Climate change has challenged biodiversity conservation practitioners and planners. In this paper, we provide scalable guidance on integrating climate change into conservation planning and adaptive management that results in the most appropriate conservation strategies. This integrated “Climate-Smart Conservation Practice” focuses on analyzing the potential impact of climate change on species, ecosystems, and ecosystem services, combined with “conventional” (non-climate) threats, and incorporating this knowledge into projects. The guidance is based on the already widely-used “Open Standards for the Practice of Conservation”, an application of systems thinking and adaptive management, which has been successfully applied to thousands of conservation projects. Our framework emphasizes a methodical analysis of climate change impacts for projects to support more productive goals and strategy development. We provide two case studies showing the applicability and flexibility of this framework. An initial key element is developing “situation models” that document both current and future threats affecting biodiversity while showing the interactions between climate and conventional threats. Guidance is also provided on how to design integrated, climate-smart goals and strategies, and detailed theories of change for selected strategies. The information and suggestions presented are intended to break down the steps to make the process more approachable, provide guidance to teams using climate change information within a systematic conservation planning process, and demonstrate how climate scientists can provide appropriate information to conservation planners.

Sickle cell disease (SCD) refers to a group of autosomal recessive disorders involving abnormal hemoglobin. Crisis is associated with increased maternal and perinatal morbidity and mortality. Caution must be used when interpreting theresults ofthesetestsduring anacute painepisode, because they may not be predictive of increased perinatal morbidity and mortality in the absence of other findings. Controversy exists regarding the role of prophylactic blood transfusion in the management of SCD in pregnancy. The exact mechanism of hemolytic transfusion reaction is not well understood, and the pathophysiology seems to be far more complex because it involves the destruction of both patient and donor RBCs. The same pitfalls of management applied during the antepartum period are also prudent after birth. Overall, pregnant women with SCD appear to be more likely to experience antepartum, intrapartum, and postpartum complications when compared with unaffected women. Access to high-risk obstetric care, patient education, and close follow-up are important to minimize maternal morbidity and mortality.

The objective of this study was to examine prior studies on maternal and neonatal outcomes with prophylactic compared with emergent blood transfusion in pregnant women with sickle cell disease. A review of the literature was performed. Twenty-one articles were identified and included in the analysis. A generalized linear mixed-effects model was used to analyze the outcomes. Pregnancy outcomes assessed were preeclampsia, pneumonia, pyelonephritis, pain crises, intrauterine growth restriction, neonatal death, perinatal death, and maternal mortality. Women who underwent emergent transfusion were more likely than women who underwent prophylactic transfusion to have the following adverse perinatal outcomes: preterm delivery (adjusted odds ratio [aOR 2.04], 95% confidence interval [CI] 1.14-3.63), pneumonia (aOR 2.98, 95% CI 1.44-6.15), pain crises (aOR 1.67, 95% CI 1.18-2.38), and perinatal death (aOR 1.84, 95% CI 1.06-3.07). Prophylactic transfusion should be reexamined as a potentially beneficial approach to the management of sickle cell disease in pregnancy.

Objective:To determine if there is a difference in the maternal and perinatal characteristics and outcomes of women undergoing a medically indicated labor induction and delivering vaginally compared to women in spontaneous labor delivering vaginally. Methods:This is a planned secondary analysis of previously published data with additional data collected for a case-control design. Maternal and perinatal characteristics and outcomes of women undergoing a medically indicated labor induction of labor and delivering vaginally were compared with the next woman who went into labor spontaneously and delivered vaginally. Results:There were 1097 women in the medically indicated labor group and 1096 women in the spontaneous labor group. The medically indicated induction group was younger (p < .0001), had less women of "other" race (p = .004), were of a lower gravidity and parity (p < .0001), had a lower Bishops' score on admission (p < .0001), had a greater proportion of umbilical arterial cord pH values <7.1 and <7.0 (p < .0001). Additionally, the induction group had longer first and second stages of labor (p < .0001). While the unadjusted rates of post-partum complications and NICU admission were higher in the medically indicated labor induction group, only cord gas pH Conclusion:Even with successful vaginal delivery of a medically indicated induction of labor, the risk for adverse outcomes remains elevated.

There is growing interest in evidence‐based conservation, yet there are no widely accepted standard definitions of evidence, let alone guidance on how to use it in the context of conservation and natural resource management practice. In this paper, we first draw on insights of evidence‐based practice from different disciplines to define evidence as being the “relevant information used to assess one or more hypotheses related to a question of interest.” We then construct a typology of different kinds of information, hypotheses, and evidence and show how these different types can be used in different steps of conservation practice. In particular, we distinguish between specific evidence used to assess project hypotheses and generic evidence used to assess generic hypotheses. We next build on this typology to develop a decision tree to support practitioners in how to appropriately use available specific and generic evidence in a given conservation situation. Finally, we conclude with a discussion of how to better promote and enable evidence‐based conservation in both projects and across the discipline of conservation. Our hope is that by understanding and using evidence better, conservation can both become more effective and attract increased support from society.

Oxidative stress is a consequence of reduction in the antioxidant capacity and excessive production of reactive oxygen and nitrogen species (ROS). Oxidative agents, which are overproduced due to ischemic-reperfusion injury in the placenta, may overwhelm the normal antioxidant activity. This imbalance is a key feature in the pathogenesis of preeclampsia. A decrease in glutathione peroxidase (GPX) activity is associated with the synthesis of vasoconstrictive eicosanoids such as F2-isoprostanes and thromboxane, which are known to be upregulated in preeclampsia. Biochemical markers of lipid peroxidation, such as malondialdehyde and F2-isoprostane in the placenta, are also increased. Adhesion molecules participate in the pathophysiology of preeclampsia by contributing to a reduced invasion by the trophoblast and increased vascular endothelial damage. Superoxide dismutase (SOD), catalase (CAT) and GPX play important roles counteracting oxidative stress. Other antioxidant factors participate in the etiology of preeclampsia. Levels of antioxidants such as Lycopene, Coenzyme 10, as well as some vitamins, are reduced in preeclamptic gestations.

Objective: To compare pregnancy outcomes in women with sickle cell disease from recent deliveries with a similar group delivered earlier. Methods: During a 12-year period (2005-2016), data from pregnant women with hemoglobin SS or SC were collected from three university medical centers and compared with earlier studies (1979-2003) involving similar patients. The primary endpoints were maternal complications during pregnancy and newborn outcomes. Results: There were 278 patients in the control group (1979-2003) compared with 150 patients in the study group (2005-2016). Women in the study group were older (P < 0.0001) and of less parity (P = 0.0001), and complications of preterm delivery, preeclampsia, and having a transfusion were similar between the two groups (P = 0.45, 0.95, and 0.49, respectively). Pain crises were more common in the study group (P = 0.02) as was cesarean section (P < 0.0001), but there was a reduction in pulmonary complications (P = 0.0002). Maternal mortality was uncommon (control group [N=4] vs study group [N=3], P = 0.40). Newborn statistics revealed a similar gestational age at delivery (37 weeks), and the incidence of intrauterine growth restriction, as well as 5-minute Apgar score < 7 did not differ by group (P = 0. 91, 0.85, and 0.16, respectively). Infants in the study group were heavier on average by approximately 220 g (P = 0.02), whereas the neonatal death rate was low (control group [N=1], study group [N=2] P = 0.60). Conclusions: Recent pregnancy outcome statistics in women with sickle cell disease have not changed through the years. Innovative strategies to improve maternal and newborn outcomes among such patients are needed.

Additional co-authors: Holly T Dublin, James A Estes, Kristoffer T Everatt, Mauro Galetti, Varun R Goswami, Matt W Hayward, Simon Hedges, Michael Hoffmann, Luke TB Hunter, Graham IH Kerley, Mike Letnic, Taal Levi, John C Morrison, Michael Paul Nelson, Thomas M Newsome, Luke Painter, Robert M Pringle, Christopher J Sandom, John Terborgh, Adrian Treves, Blaire Van Valkenburgh, John A Vucetich, Aaron J Wirsing, Arian D Wallach, Christopher Wolf, Rosie Woodroffe, Hillary Young, And Li Zhang

During pregnancy the most common metabolic complication is diabetes [1]. The American College of Obstetrics and Gynecology (ACOG) has recommended that each pregnancy be tested at 24 – 28 weeks for gestational diabetes by a two-step method (1-hour glucose assessment followed by a 3-hour glucose tolerance test (GTT) when necessary) [2]. The standard of care for those with an elevated 1-hour test involves a 3 hour GTT using either of the two widely accepted criteria (Carpenter/Coustan or National Diabetes Data Group) [2, 3]. Assessment by one of these criteria is important [1, 4].

The aim of this study was to determine, in pregnancies complicated by preterm premature rupture of membranes (PPROM), hypertension, intrauterine growth restriction, multi-fetal gestations and pregnancies 2326 weeks and >= 34 weeks' gestation, whether antenatal corticosteroids benefit the fetus. Literature review using PubMed, Web of Science, Clinical trials. gov, Cochrane Database of Systematic Reviews (1990-2015). Search terms linked special circumstances with corticosteroids. Randomized clinical trials, retrospective and prospective cohort studies, and case control studies were reviewed. In all, 468 abstracts were identified and 84 added from selected article bibliographies; of these, 503 abstracts were excluded, leaving 49 articles as the basis of review. The literature supports corticosteroids for PPROM up to 32-34 weeks without chorioamnionitis. Antenatal corticosteroids are beneficial for preterm infants of women with HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome/severe preeclampsia. Postpartum corticosteroid treatment of HELLP patients results in more rapid correction of liver enzymes, platelet counts, and urinary output, which can reduce maternal morbidity. Corticosteroids in twin pregnancies decrease respiratory distress syndrome but the effect is less than in singleton pregnancies. Corticosteroid effects on intrauterine growth restriction pregnancies are conflicting and steroid use should be individualized. Corticosteroid use for 23-26 weeks reduces neonatal mortality but not morbidity. In pregnancies of 34 weeks to 36(6/7) weeks, corticosteroids reduce respiratory distress syndrome, but follow-up studies are unavailable. No long-term adverse child developmental effects have been observed with one or two courses of corticosteroids, but three or more steroid courses lowers birthweight and organ weight, and there may be an increase in neurodevelopmental abnormalities. Longer follow up of corticosteroid-treated fetuses is required.

The aim of this study was to determine, in pregnancies complicated by preterm premature rupture of membranes (PPROM), hypertension, intrauterine growth restriction, multi-fetal gestations and pregnancies 23–26 weeks and ≥34 weeks’ gestation, whether antenatal corticosteroids benefit the fetus. Literature review using PubMed, Web of Science, Clinical trials.gov, Cochrane Database of Systematic Reviews (1990–2015). Search terms linked special circumstances with corticosteroids. Randomized clinical trials, retrospective and prospective cohort studies, and case control studies were reviewed. In all, 468 abstracts were identified and 84 added from selected article bibliographies; of these, 503 abstracts were excluded, leaving 49 articles as the basis of review. The literature supports corticosteroids for PPROM up to 32–34 weeks without chorioamnionitis. Antenatal corticosteroids are beneficial for preterm infants of women with HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome/severe preeclampsia. Postpartum corticosteroid treatment of HELLP patients results in more rapid correction of liver enzymes, platelet counts, and urinary output, which can reduce maternal morbidity. Corticosteroids in twin pregnancies decrease respiratory distress syndrome but the effect is less than in singleton pregnancies. Corticosteroid effects on intrauterine growth restriction pregnancies are conflicting and steroid use should be individualized. Corticosteroid use for 23–26 weeks reduces neonatal mortality but not morbidity. In pregnancies of 34 weeks to 36 6/7  weeks, corticosteroids reduce respiratory distress syndrome, but follow-up studies are unavailable. No long-term adverse child developmental effects have been observed with one or two courses of corticosteroids, but three or more steroid courses lowers birthweight and organ weight, and there may be an increase in neurodevelopmental abnormalities. Longer follow up of corticosteroid-treated fetuses is required.

Purpose: This study was aimed at determining if significant uterine tachysystole was associated with adverse fetal or neonatal outcomes during cervical ripening and induction of labor. Methods: Women undergoing cervical ripening and subsequent labor induction (n = 905) were assessed for tachysystole, defined as ≥6 contractions in each of 2 consecutive 10-minute windows. Women with ≥3 episodes of tachysystole were compared to women with no tachysystole. Results: Over a 5-year period, 70% of the 905 participants (n = 631) had no tachysystole, 143 had 1 or 2 episodes whereas 131 or 15% had ≥3 episodes (p = 0.991). The cesarean delivery rate was lower among those with tachysystole (28.2 vs. 34.1%), but the difference was not significant (p = 0.197). Non-reassuring fetal tracings were more common in the tachysystole group (14.4 vs. 21.4%, p = 0.017), but the Apgar scores at 5 min and the umbilical cord pH and base excess were similar between the 2 groups (p = 0.502, p = 0.435, and p = 0.535, respectively). Conclusions: Tachysystole was not associated with adverse perinatal outcomes when compared to women with no tachysystole during cervical ripening and induction of labor.

Objective: To compare the efficacy of tocolytic treatment with indomethacin (I), magnesium sulfate (M) and nifedipine (N) for acute tocolysis in women with advanced cervical dilation (4-6cm).Methods: A single center, randomized trial was carried out involving patients in preterm labor (cervix 1-6cm). Secondary analysis of women with advanced cervical dilation (cervix 4-6cm) at 24-32 weeks' gestation who received intravenous M, oral N or I suppositories comprised this study population.Results: Over 38 months, 92 women with advanced cervical dilation were randomized to one tocoloytic type. Days gained in utero (11.7) and percent remaining undelivered at 48h (60.8%), 72h (53.1%) and >7 days (38.3%) were similar regardless of tocolytic employed (p=0.923, 0.968, 0.791, 0.802, respectively). Likewise, gestational age at delivery (30.73.2) was similar between groups (p=0.771). Finally, neonatal statistics were not different when stratified by tocolytic treatment.Conclusion: There were no statistical differences between tocolytics in treating women with advanced cervical dilation. All offered significant days gained in utero after therapy, a high percentage remaining undelivered after 48 or 72h and after 7 days. It would appear from data that there may be advantages to tocolytic treatment even in women with advanced cervical dilation.

OBJECTIVE:To evaluate asphyxial patterns in term encephalopathic newborns caused by chorioamnionitis or intrapartum blood loss that resulted in cerebral palsy and allegations of obstetrical professional liability.STUDY DESIGN:As an expert witness, JKM identified term newborns with profound neurologic impairment: 18 born in the presence of chorioamnionitis and 14 with significant anemia.RESULT:In both study groups, profound depression with low 10-min Apgars was associated with early-onset seizures (88%), multiorgan failure (94%) and a partial prolonged injury to the cortex and subcortical white matter (94%). A cord arterial pH>7.00 was noted in 68% and deep gray matter injury involving the basal ganglia and thalamus occurred in only 19% of the newborns studied.CONCLUSION:The cord arterial pH and pCO2 values, early-onset seizures and paucity of isolated deep gray matter injury support that significant injury occurred postnatally despite appropriate resuscitation. This unique pattern may refute allegations of obstetrical mismanagement in the intrapartum period.

The U.S. Food and Drug Administration issued a drug safety communication on 05/30/2013 recommending "against prolonged use of magnesium sulfate to stop preterm labor (PTL) due to bone changes in exposed babies." In September of 2013, The American Congress of Obstetrics and Gynecologists issued Committee Opinion No. 573 " Magnesium Sulfate Use in Obstetrics" , which supports the short term use of MgSO4 to prolong pregnancy (up to 48 hrs.) to allow for the administration of antenatal corticosteroids." Are these pronouncements by respected organizations short sighted and will potentially result in more harm than good? The FDA safety communication focuses on bone demineralization (a few cases with fractures) with prolonged administration of MgSO4 (beyond 5–7 days). It cites 18 case reports in the Adverse Event Reporting System with an average duration of magnesium exposure of 9.6 weeks (range 8–12 wks). Other epidemiologic studies showed transient changes in bone density which resolved in the short duration of follow up. Interestingly, the report fails to acknowledge the fact that these 18 fetuses were in danger of PTD and the pregnancy was prolonged by 9.6 weeks (e.g. extending 25 weeks to 34.6 wks), thus significantly reducing mortality and morbidity. Evidence does support the efficacy of MgSO4 as a tocolytic medication. The decision to use magnesium, the dosage to administer, the duration of use, and alternative therapies are physician judgments. These decisions should be made based on a reasonable assessment of the risks of the clinical situation (PTL) and the treatments available versus the benefits of significantly prolonging pregnancy.

Antenatal corticosteroid (CS) therapy improves both fetal lung mechanism and gas exchange due to accelerated morphologic development of type one and two pneumocytes. This therapy also enhances the production of surfactant binding proteins and fetal lung antioxidant enzymes. In women with threatening preterm delivery, a single course is advocated between 24 and 34 weeks' gestation with either betamethasone (two doses of 12mg 24h apart) or dexamethasone (four doses of 6mg at 12-h intervals). Such treatment reduces the rate of respiratory distress syndrome, comorbidity, and mortality in neonates in the first 48h of life. The optimal time interval between CS administration and delivery is reported to be 1-7 days. Weekly repeat courses reduce the occurrences and severity of respiratory diseases but are associated with reduce fetal growth. Multiple courses should be avoided. However, a repeat course should be considered in women at risk of preterm birth 7 or more days after an initial course in women who remain at risk of preterm birth <34 weeks' gestation. CS may be harmful in growth restricted fetuses associated with an absent or reversed end-diastolic UA flow since they are at increased risk of acidosis and perinatal death. The purpose of this publication is to update and highlight antenatal CS therapy.