Book Review

Women, Pregnancy, and Health Care

Textbook of Prematurity

N Engl J Med 1994; 330:650March 3, 1994

Article

Textbook of Prematurity
Edited by Frank R. Witter and Louis G. Keith. 405 pp., illustrated. Boston, Little, Brown, 1993. $85. ISBN: 0-316-94917-5

In 1968 President Lyndon B. Johnson described it as shocking that in saving the lives of babies, America ranked 15th among the nations of the world. The high infant mortality rate at that time was related to the high incidence of prematurity in the United States. Despite recent advances in obstetrics and neonatal care, as well as all the efforts of the past 25 years to prevent preterm birth, preterm birth is still the leading cause of perinatal mortality and morbidity in the United States.

This textbook is organized into three major parts: antecedents, treatment, and outcome. The section dealing with antecedents summarizes issues related to epidemiology, risk screening, early detection, prevention, diagnosis, and management. Among the topics handled particularly well in this section, the chapter by Dr. Besinger on diagnosis and treatment is the best. It assesses the advantages and limitations of the tocolytic agents currently in use, with comprehensive references to source material. The chapters on cervical incompetence and risk screening for preterm delivery are excellent and very comprehensive. On the other hand, controversial subjects such as home monitoring of uterine activity and the management of premature rupture of the membranes are not well covered. In addition, the book does not dissect out and examine some of the key issues possibly involved in the causation of preterm labor, particularly biochemical, immunologic, and pathologic factors.

The second section discusses preterm delivery. The chapters on the use of antenatal steroids, modes of delivery, and antepartum testing are well handled. However, there is limited discussion of key issues, such as the prevention of intraventricular hemorrhage with the use of phenobarbital and vitamin K. In addition, this section lacks a chapter on the ethical issues surrounding the delivery of the extremely preterm infant (at 23 or 24 weeks' gestation). The third section deals with complications of preterm birth. The topics in this section are thoroughly covered and properly referenced.

In summary, this book is an excellent reference guide to the intriguing field of prematurity. It will be extremely useful for obstetricians, perinatologists, and neonatologists.

Baha Sibai, M.D.
University of Tennessee, Memphis, TN 38103