Book Review

Obstetric and Gynecologic Infectious Disease

N Engl J Med 1994; 331:338August 4, 1994

Article

Obstetric and Gynecologic Infectious Disease
Edited by Joseph G. Pastorek, II. 798 pp., illustrated. New York, Raven Press, 1994. $125. ISBN: 0-7817-0023-X

Infectious disease is a major problem in obstetrics and gynecology, but reference sources are few and far between. Pastorek has attempted to fill the void with a comprehensive textbook written by a who's who in obstetric and gynecologic infectious disease. Overall, this detailed reference will be a worthy addition to any departmental library.

The book has five sections (General Considerations, Gynecologic Infections, Obstetric Infections, Sexually Transmitted Diseases, and Diagnostic and Therapeutic Concepts). The text is enhanced by 50 color plates. The chapter on bacterial diseases in pregnancy is complete, and the part on tuberculosis is timely. The chapters on infectious wound complications will be valuable to residents in training, and those on human immunodeficiency virus and specific intraamniotic viral infections are especially noteworthy. This last mentioned chapter contains excellent, reader-friendly tables that highlight relevant information for the practitioner confronted with a viral illness in the fetus. It is unfortunate that the chapter on toxoplasma, rubella, cytomegalovirus, and herpes simplex virus (TORCH) infections and that on toxoplasmosis do not follow this format. In the former, the discussions are often cursory, and neither mentions the polymerase-chain-reaction technique that is revolutionizing the diagnosis of congenital infection.

My chief criticism of this book is that it is more a reference work than a book intended for everyday clinical practice. The details are important, but usability would be greatly enhanced if they were accompanied by expert interpretation and recommendation. These elements are all too often missing. For example, the need for routine urine culture to detect asymptomatic bacteruria and the necessity to culture for Group B streptococci at 36 weeks of pregnancy to reduce the incidence of neonatal group B streptococcal sepsis are controversial issues in obstetrics. They are discussed in some detail, but analysis of the costs of the various options receives only cursory attention. The detailed section on tuberculosis in pregnancy fails to discuss the need for or relevance of routine tuberculin testing. The use of amniocentesis to identify “asymptomatic” chorioamnionitis in women with preterm labor and intact membranes is appropriately deemed unnecessary. But how should the practitioner approach the asymptomatic patient with premature rupture of the membranes? Although amniocentesis is promoted by some for the detection of asymptomatic infection after rupture of membranes, it receives little discussion. The chapter on pelvic inflammatory disease, an important health problem, is exhaustive. Yet it makes no recommendation for antibiotic treatment, aside from supplying a long list of antibiotics and stating that further, long-term studies are required. This does little to help the practitioner choose an antibiotic for acute sepsis in a patient just admitted to the hospital. On each of these and many other topics, the expert authors could have made some recommendation.

These are minor criticisms of a major book. The details provided far exceed those in other current works, and I would strongly recommend it as a reference for either a departmental or a hospital library.

Carl Weiner, M.D.
University of Iowa, Iowa City, IA 52242