Recent Advances in Obstetrics and Gynaecology 24 is another high quality volume from the ‘Recent Advances’ series. It brings together eighteen chapters by over thirty authors, of topical analysis of developments in Obstetrics and Gynaecology in one handy volume.
Within obstetrics, nine chapters deal with a wide range of topics. A chapter on gestational diabetes highlights the back to basic principles of high carbohydrate low glycaemic index diets and yet makes reference to the introduction of insulin or oral hypoglycaemic therapy in women with incipient fetal macrosomia, even in those with apparently adequate glycaemic control.
Further maternal issues covered include a comprehensive chapter on management of shock. The importance of the team approach and well-rehearsed ‘fire drills’ in each unit is emphasised.
A very informative chapter on HIV and pregnancy from an African perspective not only explores the role of antiretroviral treatment but also discusses the more general issues such as the risks associated with breast feeding infants in low-resourced areas. Breast-feeding doubles risk of infection for an infant, yet the risks of replacement feeding may outweigh the risk of HIV transmission.
Additional fetal issues discussed include the associated problems with recreational drug use in pregnancy. Reference is made to the 2.1% of British women whose alcohol dependence subjects their fetuses to risks of growth retardation, neurodevelopment problems including behavioural problems, specific dysmorphic features, cardiac and joint anomalies.
Further fetal issues specifically dealt with include fetal macrosomia and abnormalities of the fetal urinary tract.
The place of operative vaginal delivery is discussed. This is an area of considerable interest due to training issues influencing the choice of instrument used to aid vaginal delivery. Resultant effects on Caesarean section rates are discussed as well as the likely shortfall of availability of expertise in complex operative vaginal delivery in the future.
The complexities of trophoblastic disease is described as is the success of the centralised registration and treatment system in the UK. This registry was established in 1973 and has enabled the development of effective and safe management policies which are now used worldwide.
Gynaecology is awarded a further eight chapters. The role of serum anti-Mullerian hormone (AMH) in the prediction of ovarian reserve and of ovarian response to gonadotrophin stimulation is discussed. Indeed, its role as a potential marker of obstructive azoospermia in male patients may have significant clinical relevance.
The difficult subject of conservative management of fibroids is discussed with reference to magnetic resonance guided thermal ablation therapy. Although still within the realms of research, this technique, as recognised by NICE, is showing promise for patients wishing to conserve their uterus.
A fascinating chapter is given to the ethically challenging area of pre-implantation genetic diagnosis (PGD). With the indications being continually extended, the debate regarding the place of PGD in late-onset disorders is highlighted. Its controversial role is explored with reference to parents of children needing haematopoietic stem cell transplants who are trying to ensure that their next child is free of disease or indeed are trying to provide a good tissue match for an existing sick child.
Excellent up-to-date accounts are given of clinical practice in endometriosis, recurrent miscarriage and post-menopausal bleeding. Moreover, the historical practice of ovarian surgery for polycystic ovarian syndrome is re-examined with the benefits of laparoscopy. Two thirds of women can ovulate after ovarian surgery with half conceiving within twelve months. However, women with raised BMI or infertility lasting greater than three years appear to be resistant to surgery. The role of insulin resistance in polycystic ovarian syndrome is afforded a further detailed chapter for those with an academic interest.
Of particular note is the concise but highly relevant chapter on Risk Management. This chapter gives a synopsis of all the buzzwords commonly used in this topic. It provides a useful framework for a subject which encompasses an extensive array of theories, thus enabling the reader to form a basis upon which to question preventable errors in medicine.
In conclusion, the eighteen chapters are presented in an accessible and easy to read format, which are all well referenced. Each topic incorporates a comprehensive overview, which emphasises the salient points of interest and, just as importantly, highlights areas that remain ambiguous, making this a very user-friendly aid for both busy clinicians and those sitting RCOG membership examinations. In all, this is a bookcase essential for all grades within the speciality.