Women’s health from the experts | |
2001 guidelines for clinical practice. Lesley Cotterell. Sydney: FPA Health, 2001 (328 pp). ISBN 0 9577133 8 X. |
Clinical guidelines,
especially if evidence based, are all the fashion. The author has not defined the level of evidence, but recommendations appear to be based on the opinion of experts.
Published by FPA Health (formerly Family Planning New South Wales), the book contains, as expected, a comprehensive review of all methods of contraception and it is particularly useful to have the less glamorous but commonly used methods, such as barrier methods, included. The section on oral contraceptives considers practical aspects such as starting, changing, and travelling across time zones. I would like to have seen a section on manipulating the cycle, and the use of “tricyclic” regimens. Also, Mirena is mentioned as being available only under the Special Access Scheme. As it was launched on the Australian market in January 2001, I would expect the 2001 guidelines to be up to date. There are sections on reproductive history taking and examination, common gynaecological conditions and sexually transmissible infections, as well as sections on menopause, pregnancy, sub- fertility, and sexual assault. Detailed management guidelines on the abnormal smear are covered, along with other areas of office gynaecology such as menorrhagia, intermenstrual and postcoital bleeding, and even the less common vulval problems. The section on sexually transmissible infections is an excellent summary of the infections that may be encountered in a reproductive health practice. It gives a clear outline of diagnosis treatment and follow-up. The section on pregnancy covers pre-pregnancy counselling, early-pregnancy screening, and a brief section on facilitating choices. As family planning clinics have achieved great expertise in counselling women with unplanned pregnancies, I would have expected this section to be more extensive. The section on fertility and subfertility disappointed me. The author rightly counsels against doing too many investigations before specialist referral, but she then goes on to list a number of possible investigations, which are not in a logical order and many of which would be considered obsolete. When the next edition of the Guidelines is produced, the author should involve a reproductive subspecialist, or otherwise not speculate beyond specialist referral. While I believe that the book is a valuable, probably essential, resource for the women’s health practitioner, it would have benefited from input from subspecialists in the areas of menopause and subfertility. It should also have been updated for events that occurred in 2001, and careful proofreading would have eliminated a number of typographical errors. Gabor T Kovacs
|