The fifth edition of this full-length 78-chapter strong text on infectious diseases in obstetrics and gynaecology is written by a number of authoritative authors who are both clinicians and scientists in the field. Despite the book's seemingly overwhelming bulk at over 500 pages, the reader immediately appreciates the logical division of three broad subject areas, which facilitates its use.
The chapters in Part I deal with the normal anatomy of the female reproductive tract and the role the immune system plays therein. The reader is given the opportunity to understand the delicate balance that exists between the host and colonizing organisms as well as the innate and acquired mechanisms of immunity. Alongside this wealth of information, the authors discuss current literature and make reference to novel antimicrobial peptides, receptors and cytokines involved in the immunological defence of the female reproductive tract. However, one cannot help but feel that the busy clinician may understand this more easily with the aid of schematic diagrams. This would serve not only to refresh the reader but also to illustrate the complex roles of these antimicrobial peptides and receptors in the female reproductive tract. Subsequently, there are five chapters dealing with antibiotic selection in pregnancy with a good description on drug delivery through the placental transporters in relation to maternal–fetal distribution. This is followed by clear and concise information about antibiotic timing and any potential adverse drug reactions in pregnancy. The important topic of antibiotic-induced diarrhoea is covered in depth with a useful protocol on its management.
Part II of the book look at specific organisms and the breadth of the organisms initially seems overwhelming, but the authors divide the pathogens into sections starting with viruses, where each viral pathogen is approached in alphabetical order. The advantage here is that it allows the reader to easily consult this large book with some rapidity when needed. Viruses covered include cytomegalovirus, enteroviruses, hepatitis, human papilloma virus (HPV) and human immunodeficiency virus (HIV) among others. Bacterial pathogens are subdivided into exogenous and endogenous pathogens and then there are chapters on various species, e.g. Chlamydia, Mycobacteria, among others. The degree of information on each bacterial pathogen is based on their potential disease severity for mother and baby. Each chapter is thorough and provides the reader with a good understanding of the pathogen itself, its diagnosis and the treatment. Although the authors cover Clostridium species, the textbook could benefit from more information regarding Clostridium difficile, a major hospital infection control topic. The topic of Group B Streptococci (GBS) and its recommended antimicrobial prophylaxis is covered with great care and detail. The significance of GBS, its diagnosis and the pharmacokinetics of treatment is also discussed. Of credit here is the fact that the reader comes away with the feeling that one has obtained a good understanding of the important implications of the organism and a confidence to inform their patients of this topic – a regularly visited discussion point in the antenatal clinic.
The chapters within Part III of the book cover problem areas in obstetrics, with comprehensive chapters on chorioamnionitis, infection and preterm labour and postpartum endometritis. Unique infections in pregnancy are covered with chapters on acute appendicitis, breast tissue infections and bacterial endocarditis among others. Problem areas in gynaecology are covered with a number of chapters on acute salpingitis, tubo-ovarian and pelvic abscesses, and an extensive chapter on toxic shock syndrome. Each chapter describes the epidemiology, pathophysiology, diagnostic criteria and treatment. Prevention of infection is well covered with comprehensive summary tables focusing on vaccinations. Generally, these chapters contain adequate information on these important topics, and with the use of summarized tables and flowcharts, the salient management points are well emphasized.
The appendices must be commended since they contain a number of useful practical points. An example is specimen collection and handling where the reader can access summarized protocol tables that are particularly useful. This section describes important practicalities allowing the clinician to become more astute in their specimen collection and understand these protocols before transferring specimens to the laboratory area. The appendices also have a section covering parenteral and oral antibiotics with dosage regimens in a tabulated format. There may be added benefit here to add the bacterial spectrum of cover that each antibiotic confers. This would provide more practical usage rather than serving as an antibiotic formulary and is a point for future editions. Unfortunately, the authors do not include a section on antiviral medications. Antiretroviral drugs would be an extremely important addition given the increasing prevalence of HIV. The extensive and often confusing nature of the current antiretroviral combinations in use and their side-effects could easily have been tackled here. The appendices do, however, have an excellent section on molecular diagnostic testing for sexually transmitted infections with clear schematic diagrams to inform the reader about updated methodology of important routine techniques currently in use. These include polymerase chain reaction-based testing for HIV and HPV.
Overall this is an extremely thorough and informative text on infectious diseases in obstetrics and gynaecology. It has a consistent style that keeps the reader fully engaged. Its easy readability comes, in part, from the lack of referencing within the text with selected reading lists at the end of the chapter. This makes the text reading smoother while also allowing the reader to consult selected materials for further clarification. This book's strength mainly lies in its ability to provide pragmatic information quickly and accurately with clinical relevance and incisive points for management. This book certainly has the ability to be a quick reference text despite its daunting size and the overall complexity of infectious diseases in obstetrics and gynaecology. There is no doubt that it should grace the bookshelves of any specialist obstetrician and gynaecologist as a key reference text.