Hypertension in Pregnancy 2nd Edition. Handbook of Hypertension, Volume 21 P.C. Rubin, Ed. Elsevier Science Inc, New York, NY; 2000 $235.00 ; 388 pages
Hypertension in Pregnancy, Volume 21, is one of a series of books that make up the Handbook of Hypertension. The Series Editors are W.H. Birkenhager and J.L. Reid. Volume 21 updates and replaces the previous Volume 10. Both of these books were edited by the same Volume Editor, Professor P.C. Rubin. In the more than 10 years that have elapsed between Volumes 10 and 21, there have been a number of significant advances in the field of hypertension in pregnancy, but as Dr. Rubin states in his preface, “The big breakthrough has not happened: we still do not know the cause of preeclampsia.”
The list of contributors is impressive and includes some of the foremost experts in the field. The table of contents covers the field adequately and there are no obvious subject omissions. I would have preferred a more logical organization of the chapters and I was, at times, confused by the sequence, but this in no way detracts from the value of the book as a source of up‐to‐date information.
Chapter 1 deals with the cardiovascular physiology of normal pregnancy. This seems a little out of place as the opening salvo of a book on hypertension in pregnancy. Although the chapter is well written, I think this information could have been folded into Chapter 11 (Hemodynamics in Hypertensive Pregnancy), which itself contains an extensive review of the cardiovascular physiology of normal pregnancy. Chapter 11 also covers the measurement of blood pressure (the subject of Chapter 2), and Chapter 2 itself has a section on the hemodynamics of preeclampsia. This is unnecessarily repetitive, and as I read the book I was occasionally frustrated by chapters that seemed somewhat unfocused. Chapter 3 covers the role of nutrition in the prevention of preeclampsia and offers an interesting discourse on this topical subject. Chapter 4 details the current thinking on the genetics of preeclampsia (Preeclampsia: a Polygenic, Multifactorial Disorder). I would have preferred this as the opening chapter and found it to be well researched and well written.
Chapter 9, The Endothelium and Preeclampsia, is one of the most detailed and exhaustively covered chapters and includes 241 references. I found this to be an excellent review of endothelial physiology that will be helpful to those who have little prior knowledge of the subject. I also particularly enjoyed Chapter 12 (A Review of Clinical Trials in Pregnancy Hypertension), which presents evidence‐based information. It is sobering to note that many of our current clinical practices are based on poor evidence. In some cases, evidence in support of commonly prescribed therapy is contradictory or simply lacking. In the United States, the favored drug for management of acute, severe hypertension in pregnancy is i.v. bolus doses of hydralazine. The authors of Chapter 12 present data suggesting that i.v. labetalol and oral nifedipine may be better choices because of the higher incidences of maternal hypotension, cesarean section, and placental abruption that occur with hydralazine. It was somewhat confusing to note that subsequent chapters addressing clinical management issues sometimes presented differing opinions based on what appeared to be subjective, rather than objective, evidence.
Chapter 15 is well written and addresses the topic of eclampsia in a balanced, although subjective, way. The author, who has tremendous experience in the practical management of patients with eclampsia, has attempted to present his subject in an evidence‐based fashion, which is laudable. Occasionally, however, he strays into dogmatism, leaving little room for discussion. This occurs in the section on oliguria, where low‐dose dopamine infusion is presented as a recommended second‐line therapy after conservative volume expansion. Further, the author supports invasive pulmonary artery monitoring as a measure that should be instituted if the above two initial strategies fail. Dopamine therapy has never been shown to improve kidney function or long‐term outcome in severe preeclampsia and is not a standard of care anywhere in the world (other than in the author's unit). Invasive monitoring is now seldom employed in cases of oliguria, since a noninvasive alternative, such as echocardiography, can provide adequate information to manage most preeclamptic women with oliguria. Many obstetricians will simply tolerate the oliguria as long as the blood creatinine level remains normal, since in most cases this is a self‐limiting condition with minimal long‐term adverse effects.
Chapter 16, which deals with magnesium sulfate, is well written and complete and presents important information about this drug. Placing it earlier in the book would have given the reader a better understanding and perspective regarding a number of the preceding chapters that deal with the management of the patient with preeclampsia/eclampsia.
Chapter 17 covers the children of hypertensive pregnancies. It presents sobering information on cerebral palsy and cognitive development in these children.
I found this book to be a valuable addition to my library and one that provides a useful update on both basic science and clinical issues in hypertension in pregnancy. My criticisms are few and minor and center around the sequence of the chapters, the lack of a central orientation favoring an evidence‐based presentation of the data, and repetition in some of the chapters. I recommend this book to the trainee as well as to the senior clinician/scientist interested in this field of medicine.—Michael A. Belfort, MD, PhD, Professor, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT