Book Review

The Fetus as a Patient: Advances in diagnosis and therapy

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

Article

The Fetus as a Patient: Advances in diagnosis and therapy
Edited by Asim Kurjak and Frank A. Chervenak. 562 pp., illustrated. New York, Parthenon, 1994. $98. ISBN: 1-85070-558-5

Without question, the technological revolution of the past two decades has elevated the fetus to the level of the corecipient of obstetrical health care. Thus, The Fetus as a Patient, edited by Asim Kurjak, M.D., and Frank A. Chervenak, M.D., is a timely look at the mysteries that cloak the world of the fetus. The editors have assembled a world-renowned group of researchers from the International Society of the Fetus as a Patient in an effort to review the fetal diagnostic and management techniques available to clinicians.

The authors weave the chapters into a carpet from the four corners of the world and take the reader on a magic carpet ride through the historical events that have established the fetus as a patient entitled to care. These advances in fetal health care are highlighted by sections on new dimensions in fetal and placental imaging, antenatal assessment of the fetal condition, the role of Doppler ultrasonography, and fetal therapy. The cornerstones of the book cover such issues as “the central role of the fetus as a patient in defining an ethical standard of care for fetal therapy,” prenatal diagnosis of skin disorders, intrauterine growth retardation, sonoembryology, and three-dimensional ultrasonography.

Nevertheless, the book is limited in scope and represents, at times, a compilation of personal research rather than a comprehensive overview of fetal health care. This is illustrated by the chapter “Non-Directive Prenatal Genetic Counseling,” in which the discussion of prenatal diagnosis is limited to postconception issues and fails to emphasize or recognize preconception counseling and alternative approaches to parenthood to help prospective parents avoid having a fetus with serious defects.

Other chapters provide a comprehensive assessment of a selected fetal clinical condition, such as intrauterine growth retardation, but do little to guide clinicians through the complex tapestry of science and technology and their bedside applications. Other chapters, such as “Transvaginal Evaluation of the Cervix,” should have been left out, because they do not appear to apply directly to the management of fetal health care. In future updates, the editors should consider including chapters that focus on the legal issues confronting the fetal clinician, RH sensitization, and fetal risk management.

In summary, The Fetus as a Patient is a brief but important glimpse into the world of the fetus. The thought of future editions of the book, which will expand on this initial effort, is enticing. Unfortunately, the book is too short and its coverage of fetal health care issues too brief. In a world that tends to focus on maternal rather than fetal issues, The Fetus as a Patient is an eloquent reminder that both issues are important.

Jeffrey P. Phelan, M.D., J.D.
Pomona Valley Hospital Medical Center, Pomona, CA 91767