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Obstetrics: Normal and Problem Pregnancies
3rd ed, edited by Steven Gabbe, MD, Jennifer R. Niebyl, MD, Joe Leigh Simpson, MD, 1348 pp, ISBN 0-443-7690-1, New York, NY, Churchill Livingstone Inc, 1996.
Arch Fam Med. 1998;7:386.
Edited by 3 obstetricians, this reference text emphasizes abnormal obstetrics and only occasionally remembers to include the family, father, or significant others in discussions. Family physicians are mentioned once as a potential source of prenatal care and again as a source of referral for preconception counseling of women with high-risk pregnancies.
The writing style, breadth, depth, and documentation of references vary from chapter to chapter. The chapters about the anatomy of the pelvis, endocrinology, and diagnosis of pregnancy and preterm labor are exhaustive. The chapter about labor and delivery seems to lack depth and the author's opinions are mixed with recommendations that are based on research. In this chapter, the author suggests the use of 15 to 30 mg of morphine for the treatment of a prolonged latent phase of labor. There are no references for this recommendation and I must, therefore, assume it is based on clinical experience and personal preference.
In contrast, the chapters about fetal wastage and postdate pregnancies allow the reader to distinguish between recommendations based on review of the medical literature and the clinical experience of the author.
The content of individual chapters is variably responsive to the current medical climate and current diseases of importance. For example, the discussion of electronic fetal monitoring provides a clinical perspective that was not included in the epidemiologic studies that recommend against the use of electronic surveillance of low-risk pregnancies. However, human immunodeficiency virus and acquired immunodeficiency syndrome receive less attention than would seem warranted. The discussion is very short in the sections about screening and the treatment of high-risk pregnancies and receives only 3 pages in a 50-page chapter about perinatal infections. Human immunodeficiency virus is clearly mentioned as a contraindication to breast feeding. Some lack of current information in a rapidly changing field is inevitable owing to the time required to publish and market any large book. However, even 5 years ago, human immunodeficiency virus in pregnancy was a major concern and research was underway to find ways to decrease maternal-fetal transmission. The section about meconium aspiration lists treatment recommendations that have been modified during the past few years and clearly outlines the changes and reasons for modification.
Practical information that can provide a quick reference for the practicing physician is listed in a few chapters. The list of common drugs and the teratogenic potential of each drug or class of drugs is very useful. Including copies of the American College of Obstetricians and Gynecologists, Washington, DC, antipartum record is less valuable. The protocol for the use of specific tocolytic drugs for preterm labor is based on the author's personal experience but is a good reference for physicians who rarely use these medications.
The section about shoulder dystocia is well done and has simple but clear illustrations. The list of 10 key points at the end of each chapter is a nice attempt to summarize the author's emphasis in the chapter but seldom includes practical information that would suggest specific actions or treatments.
This book is an interesting enigma. I do not believe that it is useful as a primary textbook for medical students owing to its limited information about prenatal care and labor and delivery in the uncomplicated pregnancy. Its lack of family emphasis in most chapters limits its use in family practice residencies. The bulk and depth of several chapters prohibit its usefulness as a rapid reference for the practicing family physician. However, I believe that it will be a nice addition to the reference library of any office or hospital that cares for women who are pregnant and their families. And for any physician who last read about the hormones of pregnancy more than 10 years ago, the chapter about the endocrinology and diagnosis of pregnancy is a must read. I will refrain from saying they have "come a long way, baby."
Barbara P. Yawn, MD, MSc, Reviewer
Olmstead Medical Center
Rochester, Minn
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