Medical disorders in obstetric practice, 4th ed.

Michael de Swiet, editor

Figure.

Malden (MA): Blackwell Science; 2002. 616 pp; US$146.95 (cloth) ISBN 0-632-05395-X

Rating: ***

Audience: Residents in obstetrics, generalists

Content: For obstetrics residents and for generalists due for a review, this book is engaging and fluent enough to be read at the lake, yet meaty enough to provide a sense of familiarity and confidence for readers faced with medical problems in pregnant patients. For the internist newly or infrequently consulting in obstetrics, it provides enough information to assuage that all-too-common sense of discomfort when dealing with 2 patients, one within the other. However this is not a sufficiently exhaustive reference for perinatologists or subspecialists in obstetric medicine.

This book is a refreshingly readable and concise overview of medical problems likely to be encountered in obstetric practice, ranging from diseases of the major organ systems through infection to substance abuse and psychiatric illness. It provides an elegant review of basic physiology and pathophysiology, discusses the impact of disease on pregnancy and pregnancy on disease, and gives useful recommendations for clinical care.

Strengths: De Swiet and most of his co-authors write beautifully, and their clinical acumen is evident. Tables and figures are few but appropriate: for example, the list of occult causes of collapse in pregnancy is brilliant. Drug doses, routes and half-lives are consistently provided; this is particularly useful in the delivery room at 3:30 am. I used the helpful index to look up a dozen questions I have recently faced. Those relating to common problems were well addressed on the basis of evidence and the authors' experience. This book feels ‘just right’ as a concise but useful synopsis.

Limitations: There are significant errors and omissions. For instance, carbamazepine is missing from the list of enzyme-inducing antiepileptic drugs affecting fetal coagulation; cesarean section is suggested based on herpes culture results at term; bromocriptine is suggested for lactation suppression; current information about teratogenic risks of trimethoprim is missing; and a urine pregnancy test is claimed to be unreliable on the basis of a reference dating back to 1967. I found no reference to glucose-6-phosphate dehydrogenase deficiency, a not-infrequent issue in pregnancy. The chapters on gastrointestinal and liver disease suffer from poor English, an inability to distill from the literature coherently, poorly founded recommendations, and obsolete references (e.g., in the hyperemesis section). Some minor annoyances include mislabeled references and typos.

Erica Eason Associate Professor Obstetrics and Gynecology University of Ottawa Ottawa, Ont.

This book is available through your local book retailer, or through the publisher at www.blackwellpublishing.com/book_default.asp