Step-by-step caesarean section.

Caesarean section. A manual for doctors.

Caroline M De Costa and Paul Howat. Sydney: MJA Books, 2006 (v + 104 pp). ISBN 085557 045 8.

Caesarean section is a must for any doctor considering obstetrics. It is well written, easy to read, exceptionally informative, and practical. It was written by two rural obstetricians with a wealth of experience, in collaboration with two anaesthetists. I know from personal experience that both authors spoke with many colleagues to find out how they cope with some of the difficult caesarean complications.

My only criticism of the book is that there is some repetition of the topics, particularly anaesthetics, but that happens because each chapter could be considered to be a small monologue that stands alone.

The organisation of the book is very good. It begins with the decision-making process that is necessary before performing caesarean section, goes through informed consent, and gives the pros and cons of carrying out the procedure and its anaesthetic. For readers who have not performed a caesarean section, or may have only performed a few, there is a good description of how to proceed. There is also a description of the basic surgical instruments required.

After dealing with the basic procedure, the book describes some complications of caesarean section (eg, difficulties delivering the head). There is a chapter devoted to intra- and post-operative bleeding and practical hints for coping with the various causes of bleeding. Further chapters deal with caesarean section for placenta praevia and the indications for a classical caesarean section and how to perform it.

The management of caesarean section in women who are HIV positive, and sterilisation at the time of caesarean section are discussed. The last two chapters deal with anaesthesia for caesarean section and are very good reading for procedural general practitioners who may need to administer anaesthetics, particularly in rural areas. One deals with regional anaesthesia (epidural, spinal, and combined anaesthesia); the other deals with general anaesthesia, outlining the potential problems of giving a general anaesthetic to a pregnant woman and how to cope when unable to intubate a pregnant woman.

There is also a good appendix detailing references for further reading.

In summary, this is an excellent practical book which should be read by all doctors who are about to embark on performing caesarean section and anaesthesia. It is also of value for experienced practitioners as it describes how other people have coped with some of the difficulties of caesarean section.

Ian PettigrewAssociate Professor, Department of Rural Obstetrics and Gynaecology, Monash University, Mildura, VIC Order this book