Book Review

Pathology of Multiple Pregnancy

N Engl J Med 1994; 330:1625June 2, 1994

Article

Pathology of Multiple Pregnancy
By Virginia J. Baldwin. 409 pp., illustrated. New York, Springer-Verlag, 1993. $165. ISBN: 0-387-94011-1

This book is close to art: not because it is a labor of love or because the amount of labor involved is massive -- both of which are true -- but because the labor has been intelligent and disciplined. As a result, several virtues have been achieved.

One is that the book is well written and well organized. The sentence structure is simple and straightforward. The chapters are placed in logical sequence. Each chapter or subsection begins with a description of the topic and its relevance. What is known is reviewed, and the reviews are not superficial; instead, they are selective and detailed enough to reveal substantial scholarship. The author's extensive personal experience is described, followed by a discussion progressing from knowledge to speculation. This structure lays bare each point at which the known stops and questions arise. A lifetime of research is outlined in almost every area discussed. Although anyone interested in developmental biology should become familiar with this book, this aspect of Pathology of Multiple Pregnancy makes it particularly valuable for young academicians looking for something to spend the rest of their lives doing. I was most impressed by this feature of the book in the clinically relevant chapter on twin-to-twin transfusion.

Baldwin truly makes it clear how the clinical pathologist, with standard simple tools, can ask and answer fundamental questions about the outcome of multiple gestation. She also indicates when more sophisticated studies are required. The discussion of the mechanism of twinning and the ambiguity of zygosity should be mandatory reading for all who interpret or cite twin studies.

There is only one thing I did not like. The author frequently insists on the importance of the topic under discussion in terms, medicolegal and otherwise, that suggest she has frequently had to justify her interest. Artists have always had to please the market, but it is not a pretty sight.

Reproduction is a miracle, and perhaps contrary to expectations, greater knowledge increases rather than decreases one's awe. A few weeks ago, when I participated in the successful delivery of four infants at the same time, I knew I had witnessed something extraordinary, but after reading this book I think I was standing on holy ground.

Tim H. Parmley, M.D.
University of Arkansas Medical Sciences, Little Rock, AR 72205