Postgraduate Medical Journal 2004;80:124
This is an excellent book, which is easy and enjoyable to read. It meets the target the editors set out with, highlighting “ the extraordinary variety and broad expanse of the speciality”. Furthermore it is refreshing that many chapters address the ethical and psychological aspects of obstetrics and gynaecology.
The first nine chapters are based on RCOG lectures and the following 24 chapters form an odyssey through contraception, pregnancy, delivery, postpartum problems, and gynaecology. The book covers a wide variety of subjects and topical issued, addressing area often neglected. It is clear and well laid out.
The chapters are well written and reviewed. Some are thought provoking and provocative. Although it includes coloured illustrations and photographs, they are all accumulated in the middle part of the book and add little to the text.
This book will be useful for trainees studying for their membership exam and certainly is an interesting read for consultants and will help them to keep up-to-date with recent advances.
At £48 for 420 pages, the book is reasonably priced.
C C T Wiesender
Consultant Obstetrician and Gynaecologist, Leicester General Hospital
Journal of the Royal Society of Medicine 2003;96:615
It may seem strange that, in an age of high technology a key topic in obstetrics and gynaecology should be the use of a few centimetres of synthetic tape to support the urethra. Tension-free vaginal tape (TVT), which has only recently gained popularity in the UK though long used in Continental Europe, is awarded a whole chapter in the 2003 Yearbook of Obstetrics and Gynaecology. In this operation for genuine stress incontinence, a vertical incision is made in the anterior wall of the vagina and the tape is inserted to both sides of the urethra and out through two small lateral incisions just above the pubic symphysis. The operation is tension free in that the ends of the tape are not sutured. The long-term success rate with this procedure approaches 80%-about the same as that of the colposuspension and sling operation, but with shorter hospital stays and lower morbidity. It is thought to work by kinking of the mid portion of the urethra rather than bladder neck elevation (the mechanism with colposuspension). Complications are usually minor, although vascular damage and even deaths have been reported: urgent laparotomy is required if large vessel damage is suspected. The technique does not usually require general anaesthesia, and the low-tech equipment means that it is applicable in developing as well as developed countries. With the increasing use of TVT, more women will be cured of the common and distressing condition of genuine stress incontinence.
Every chapter in this year’s volume is instructive, but let me mention some others that especially caught my interest. Anyone involved with obstetric and labour ward care will appreciate the discussion of cerebral palsy and the new ideas on its aetiology. A widespread belief (fuelled by court cases) that the brain damage occurs during labour-through hypoxia, acidosis or other insults-rather than antenatal, has led to a climate of anxiety in obstetrics, with increasing intervention rates. The chapter makes clear that cerebral palsy is a spectrum of conditions caused by an interplay of factors including extreme prematurity, chorioamnionitis, inborn errors of metabolism and inherited thrombophilias. Postnatal factors may include the use of corticosteroids and hypocapnia from mechanical ventilation. This chapter deals well with a subject poorly covered by some textbooks.
Another burning issue is the increasing trend towards elective caesarean section in the UK. For many doctors, it is hard to see why any woman should choose an elective section when there is no ‘obstetric’ indication. The chapter evaluates recent publications on the risks for mother and baby, and the facts therein will be a helpful resource for clinicians in what can sometimes be a challenging consultation.
Though written primarily for obstetricians and gynaecologists, there is much in this yearbook that will interest neonatologists, paediatricians, urologists, endocrinologists and microbiologists-and, indeed, anyone who offers care to women and children.
Laurie Montgomery Irvine
Watford General Hospital, Watford
