Book Review

High Risk Pregnancy: Management options

N Engl J Med 1995; 332:477-478February 16, 1995

Article

High Risk Pregnancy: Management options
Edited by D.K. James, P.J. Steer, C.P. Weiner, and B. Gonik. 1318 pp., illustrated. Philadelphia, W.B. Saunders, 1994. $90. ISBN: 0-7020-1575-X

This ambitious textbook covers the entire scope of clinical maternal–fetal medicine. High Risk Pregnancy: Management Options distinguishes itself from other standard perinatology textbooks, such as Maternal–Fetal Medicine: Principles and Practice (edited by Robert K. Creasy and Robert Resnik. Philadelphia: W.B. Saunders, 1994), in presenting clinical information almost exclusively and omitting much basic-science information. Internationally recognized experts on the subject wrote most of the chapters.

The book's 73 chapters appear to be organized into four basic sections — general obstetrics, medical complications of pregnancy, prenatal diagnosis and fetal disease, and management of labor and delivery — although the sections are never listed. This is an important omission, since the editor states that “all the contributors to each section were asked to give their preferred management in all areas of their section.” All chapters contain boxed lists that in most cases provide adequate summaries of the material and that will facilitate use in clinical practice. I found a number of minor typographic errors in the book as well as one major error in a discussion of pheochromocytoma, in which “beta-blockade” was used when “alpha-blockade” was intended.

The preface and back cover list a number of goals for the textbook. The first is to be comprehensive. In fact, the editors have succeeded in covering all major topics, and most chapters are quite thorough. A few additions would have been helpful, including a more complete discussion of uterine and cervical abnormalities and a discussion of trauma in pregnancy. There is some overlap in topics, but this sometimes enhances the treatment of the subject. For example, a brief discussion of tuberculosis in a chapter on respiratory tract disease is followed by more thorough coverage in a chapter on infectious disease. The overlap is distracting in other places, as in a chapter on abdominal pain in which most of the information is covered in more detail elsewhere.

The editors also tried to present a “wide range of established management options.” In this regard they were usually successful. Most chapters provide a balanced review of the topic and offer a defensible range of practice options. In a few chapters, the authors' bias about accepted practice seems apparent, as in the chapter on testing of fetal well-being before labor and the chapter on fetal growth deficiency. I found very few statements that are clearly erroneous. Most authors support their advice with appropriate data. A few authors, however, cite review articles, and others offer out-of-date references.

A third goal of the textbook was to present practical information. There is little basic science or tangential clinical information. Most authors cite appropriate studies to justify their recommendations. By and large, the clinical approach is based on common sense and appropriate evidence.

The editors intentionally enlisted contributors from many countries to provide a multinational perspective. I suspect that readers from the United States will have both positive and negative reactions to this approach. Some chapters contain terms and practices that are not common in the United States. Readers may fall prey to prejudice about the opinions of foreign experts and about data obtained outside the United States. For my part, I appreciated the diversity and found that the United Kingdom contributors were more likely to base their recommendations on evidence.

My overall impression of this textbook is very favorable. There are a number of excellent chapters, including an outstanding review of fetal distress in labor. High Risk Pregnancy will be a valuable resource to a variety of practitioners, including upper-level obstetrics residents, maternal–fetal medicine fellows, and practicing perinatologists, general obstetricians, and midwives.

Emily R. Baker, M.D.
Dartmouth–Hitchcock Medical Center, Lebanon, NH 03756