BOOK REVIEW

Abstract

PJ Steer, MA Gatzoulis & P Baker, editors. Heart disease and pregnancy. RCOG Press, 2006. The number of pregnant women with heart disease is increasing dramatically, primarily due to the growing number of adults with congenital heart disease. Many of these patients require highly specific care, not only during pregnancy and the peripartum period, but also prepregnancy. Health professionals, i.e. gynaecologists, obstetricians, cardiologists, anaesthetists etc., who deal with female patients in the childbearing age groups, have a responsibility to ensure that these patients receive optimal information and care. For obvious reasons, the experience dealing with these new patient groups remains scarce, and is mostly based on an individual's own experience. Hitherto, little information on these important issues has been accessible, and many women are, therefore, receiving insufficient information and suboptimal management during pregnancy and delivery. This notion is, to some extent, underscored by the fact that heart disease is currently the leading medical cause of death in relation to pregnancy. For these reasons, the Royal College of Obstetricians and Gynaecologists in London brought together a group of international specialists with extensive personal experience on pregnancy in women with cardiac disease. At the meeting, a ‘baby’ was conceived. Little is know about the course of the ‘pregnancy’, but 9 months later a lively ‘baby’ was born. Although, only 634 g and 23.5 cm – definitely not small for gestational age. The book provides the reader with much information on prepregnancy counselling and contraception, on antenatal, intrapartum and postpartum care, and, finally, some consensus views. The 43 ‘fathers and mothers’ have done a great job. Most subsections are of high informative standard, a small minority seem redundant. If the book is read in total, the reader may find much repetition, but although this, at first hand, may seem a little annoying, it is undoubtedly a surplus once the book is used on a day to day basis for quickly obtaining information, although one has to be aware that most of the information provided is based upon opinion rather than scientific data, as also underlined in the preface. Hopefully, this book only remains the first attempt to produce and share this information with the rest of us. Since all the authors are extremely dedicated to this group of young patients, we can only enjoy this book, which could and should only be the first edition. With increasing awareness and increasing number of patients, it is now timely and appropriate for the authors and the rest of us dealing with these patients to provide hard data that would push the panel to provide us with new editions on a regular basis. If all members of the many specialities involved in the care of these patients bought the book, we could perhaps speed up this process and soon await the next version. Finally, a word of caution. Although with this excellent book at hand, many small centres may feel tempted to set up their own programme, thus failing to recognise the need for specialist opinions as clearly stated in the book. However, all young women with heart disease, whether prepregnant or pregnant, should initially be referred to a high-volume, high-risk specialist unit for baseline evaluation and optimal planning of the need for and level of the required pregnancy follow-up. We need to appreciate that it takes more than a good recipe to become a Michelin star chef, but it provides us with a better basis for home cooking.