V. Clark, M. Van de Velde, R. Fernando (eds)
OUP; 2016, PP 1008, ISBN: 9780198713333
This book is available in both hardback and online versions, although the latter is only accessible via an institutional subscription. For the purposes of this review, the publisher only allowed access to the online version.
In the preface, the editors highlight ‘the sometimes conflicting needs of the mother and her baby, the different physiology of pregnant woman compared to her non-pregnant counterpart, the increasing complexity of care of the pregnant woman due to factors such as rising maternal age, obesity, and co-morbidities which in the past may have precluded pregnancy’. Consequently, they set out to provide ‘a comprehensive, up-to-date textbook covering all aspects of care for parturients, including recent approaches to neuraxial anaesthesia, new technologies, drugs, protocols, and guideline’. The editors indicate that they have drawn together a group of international contributors who are experts in their fields and who not only provide in-depth, evidence-based chapters on obstetric anaesthesia but also include practical information and guidance that they hope will be of value for those working in the maternity environment, wherever they happen to practise.
This is a large book (1008 pages, 55 chapters), and the ‘pdf’ file index extends to 120 pages. The book is divided into 10 sections: history of obstetric anaesthesia; maternal and fetal physiology; fetal and neonatal assessment and therapy; fertility treatment, anaesthesia for non-obstetric surgery and drugs in pregnancy and lactation; obstetric management of labour and labour analgesia; anaesthesia for caesarean delivery; anaesthetic complications; obstetric complications; systemic disease in pregnancy; and, recent advances in obstetric anaesthesia. Although not stated, individual chapters appear to be ‘stand alone’ and, as a consequence, there is considerable repetition throughout, and not infrequently with a different emphasis and conclusions. For a trainee, these contradictions may lead to some confusion, but for an experienced and well-read obstetric anaesthetist there may be frustration at statements with no supporting evidence provided. Perhaps the most prevalent example of the latter, with possible far reaching consequences, are statements in various chapters that ultrasound ‘accurately identifies lumbar interspaces’. Even in the chapter dedicated to ultrasound, apart from the statement that it is better than palpation, there is no discussion of its real accuracy or, more importantly, its real accuracy in difficult cases.
From my own point of view, I was disappointed at the inference that chronic changes in maternal spinal canal volume are responsible for the enhanced spread of spinal anaesthetics in pregnancy, and that gravity is the main determinant of spinal anaesthetic spread in pregnant women, despite the evidence regarding acute changes in maternal posture.
A small, but important topic not addressed at all in the book, is the woman described by midwives as ‘not in labour’ whose contractions are causing extreme pain. This subject should merit some discussion in such a comprehensive textbook as it has both clinical and medico-legal consequences.
It is also worth pointing out the all-encompassing nature of the book, hinted at in the preface by the words ‘practical information and guidance for those working in the maternity environment.’ There are whole chapters, and considerable portions of other chapters, that are of direct clinical relevance to paediatricians, obstetricians, or psychiatrists but have little direct clinical relevance to an obstetric anaesthetist, e.g. chapters including peripartum psychiatric disorders, antenatal fetal evaluation, fetal medicine, specific descriptions of antenatal obstetric management, and surgical techniques.
A significant advantage of an online textbook is said to be the search facility. A simple search (e.g. fasting) produces a list of chapters each with some three lines of text before and after the highlighted search word. Unfortunately, of the 33 chapters identified, only 10 may be of some relevance. The other 23 highlight any word containing ‘fast’, ‘fast fibres’, ‘fast onset’, ‘fast heart rate’, ‘faster absorption’, ‘faster labour’, ‘faster conduction’ etc. There is no advanced search facility, and the use of inverted commas around a word or words makes little difference to the relevance of what is found. When a chapter, with its six lines of text is identified, there may well be other instances of the search term within that chapter which are not shown in the search results but will show up if that chapter is then clicked and read through carefully. When reading a chapter online there is no possibility of searching within that chapter – the whole book is searched. To search within a chapter, one needs to download the ‘pdf’ file of the chapter, but one then needs to be aware that downloading chapters as a ‘pdf’ file has copyright restrictions. In summary, the search facility is useful, but it does require significant development.
Nevertheless, despite the above, I believe this book meets the aims of the editors and should be an essential part of any institutional subscription.
Ian F. Russell