Treating for two | |
Medical complications during pregnancy. 6th ed. Gerard N Burrow, Thomas P Duffy, Joshua Copel (editors). Philadelphia, Penn: Elsevier Saunders, 2004 (xiv + 565 pp). ISBN 0 7216 0435 8. |
Over the last 50 years
maternal mortality reports have shown a rearrangement of the causes such that, in more developed countries, maternal medical disorders are now the dominant contributors. The statistics for severe obstetric morbidity demonstrate the same predominance of “medical” afflictions. This has occurred partly because of dramatic improvements in the management of obstetric conditions, but also because the pregnant population is ageing, and many more women with medical problems now chance pregnancy. It is no longer surprising when a 40-year-old obese smoker with type 2 diabetes, hypertension, ischaemic heart disease and renal impairment presents late in the first trimester for antenatal care! The complexities in the management of such patients — medical, pharmacological, obstetric, laboratory and psychological — comprise the subject matter of this worthwhile text. It is directed at physicians, obstetricians and general practitioners and covers amply the full range of medical problems seen in pregnancy. In a large multi-authored text, editorial oversight is important to maintain uniformity of style and distribution of priorities. There has been some laxity here, with idiosyncratic chapter length, detail in coverage and placement of topics. The chapter on pulmonary disease is more than three times the length of that covering renal disease. This does not reflect clinical reality. Eclampsia is dealt with in the neurology chapter rather than with pre-eclampsia, and cholestasis of pregnancy is detailed correctly in the liver chapter, but also at length in the dermatology chapter. A detailed scientific treatise on the immunology of pregnancy has no practical utility, and need not appear in this clinical text, and the impassioned coverage of smoking in pregnancy appears in the “Pulmonary” rather than “Substance Abuse” chapter. However, the full gamut of medical disturbances that are seen in pregnancy is well covered. Appropriately sandwiched between “Genetics” and “Emergency management” is a discourse on “Ethical issues in obstetrics”. Though interesting, it has no specific relevance to the book. A chapter dealing specifically with implications for the infant of maternal medical disease would have been more useful. Most physicians see few pregnant women and most obstetricians left internal medicine years ago. This text will be helpful for practitioners in either field who find themselves in unfamiliar territory. Barry N J Walters
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