BOOK REVIEW

Abstract

J Norman, I Greer, editors. Preterm Labour. Managing Risk in Clinical Practice. 417 pages, tables, figures. Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo: Cambridge University Press, 2005. ISBN-10 0 521 82186 X Hardback, ISBN-13 978 0521 821 865 Hardback. Price: GBP 70.00, USD 100.00.. No sooner had I dispatched a review on a book named Preterm Birth than another with a deceptively similar name landed on my desk. Both are British, the former issued by the Royal College of Obstetricians and Gynaecologists, while Preterm Labour comes from Cambridge University Press, with 27 contributors and a leaning toward experts from Scotland. I recognize one name common to both books: Phillip Bennett, who in the present volume has coauthored the chapter “Transcriptional regulation of labour-associated genes”, with a host of information about every conceivable gene that encodes enzymes involved in prostaglandin biosynthesis and metabolism. Preterm Labour starts with a chapter on epidemiology, in which Peter Danelian and Marion Hall discuss the enigmatic definitions of “preterm” and “gestational age” and go on to elucidate the paradoxical rise in rates of preterm delivery. All possible causes are listed, with emphasis on sociodemographic factors. Andrew Thomson and Jane Norman describe the biology of preterm and term labor from anatomical and biochemical points of view, with final comments on the role of infection and the sobering view that current evidence does not support screening and treating all pregnant women for bacterial vaginosis to prevent preterm labor. In “Fetal outcome following preterm delivery”, Malcolm Levene and Lawrence Miall cover the complications and sequelae comprehensively, emphasizing that age at delivery is crucial. They include studies on cognitive ability, behavior, quality of life, and growth in early childhood, and mention adolescent and adult outcomes insofar as such studies have been published. Philip Owen and Fiona Mackenzie write about prediction of preterm labor, while John Morrison and Nandini Ravikumar cover its prevention. Prediction by risk scoring has not been found useful, while fetal fibronectin in cervical secretion has some discriminative power in differentiating true from false preterm labor; the value of uterine activity monitoring is still unsettled. Prediction by cervical ultrasound has some useful clinical implications, while salivary estriol, corticotrophin-releasing hormone, relaxin and inflammatory cytokines, and other circulating factors do not. The authors on prevention pay much attention to socioeconomic, racial, and lifestyle factors. Maternal disorders should ideally be attended to prior to pregnancy onset; prophylactic tocolysis will delay delivery following preterm labor onset for 24–48 hours, but there is no significant effect on a number of specific outcome measures. Similar considerations apply to cervical therapy (cerclage) and antimicrobial therapy. The same treatment options reappear in the chapters on management of preterm premature ruptured membranes (by Donald Peebles), management of threatened preterm labor (by Manu Vatish and collaborators), and management of preterm labor, with specific complications like multiple pregnancy, pre-eclampsia, and fetal growth restriction (by Mark Kilby and David Somerset). This splitting up of a theme regrettably invites repetition. Anesthetic issues are covered by Anne May and Chris Elton and a long chapter on management of the preterm neonate by Richa Gupta and Michael Weindling. The final chapters are devoted to organization of high-risk obstetric and neonatal services (by Karl Murphy and Sara Twaddle), management of pregnancy and labor (by Sheila A.M. McLean and Sarah Elliston) and finally, “Treating the preterm infant – the legal context” by Sarah Elliston. These chapters mainly refer to the British systems but make for interesting reading to anyone interested in health care delivery systems and legal matters. The list of references at the end of each chapter is impressively long. All in all, Preterm Labour. Managing Risk in Clinical Practice is an excellent monograph on an important clinical subject. It is as comprehensive as may be expected and should be of interest to obstetricians and neonatologists who want an authoritative update.