Book review

Abstract

R. Collis, F. Plaat and J. Urquhart, eds Greenwich Medical Media, 2002 A comprehensive textbook of obstetric anaesthesia based on UK practice has been missing from the bookshelves for a long time. I have been eagerly awaiting this book in anticipation that it would fill this niche. In general, the layout is good with each chapter starting with a clear contents list. Several of the chapters include highlighted key points, which were particularly effective in the chapter on maternal cardiac disease. The illustrations do not stand out, but there are some useful flowcharts for the management of various conditions and circumstances, for example, pre-eclampsia. The obligatory chapter on history is well written and informative. Other good chapters include a thorough exploration of amniotic fluid embolism (AFE) and a useful one on fetal monitoring. The chapter which non-specialist obstetric anaesthetists will find most worthwhile to browse is that on ‘anaesthesia during pregnancy’. It covers clearly all aspects of anaesthetising pregnant women for non-obstetric procedures. This book does, in my opinion, fail to deliver in some areas. The chapters on regional analgesia and anaesthesia give a reasonable overview of what I recognise as established UK practice in a lot of units, but fail to adequately cover, in my mind, the complications of the techniques with, in particular, a very limited discussion of post-dural puncture headache. The inclusion of a whole chapter on ambulatory analgesia, although interesting, is very much an expression of the author's personal practice and leads one to the conclusion that if a mother wants to remain ambulatory in labour she must have a combined spinal–epidural technique. This, would not I think, necessarily be a consensus view across the UK. There are some surprising omissions: multiple pregnancies are mentioned only as risk factors for pre-eclampsia and AFE. Where is the discussion on management of these cases? The chapter on audit talks only sketchily about the Confidential Enquiry into Maternal Deaths. There is some overlap in some of the other chapters but the audit chapter fails to convey how much effect the enquiry has had on shaping practice in this country. A shame when the present structure of the enquiry is about to be altered. The increasingly important and worrying areas of consent and the medico-legal aspects of obstetric anaesthesia have been totally ignored. The book feels unbalanced, which may be inevitable with a multi-author text, but this is illustrated by the chapter on pre-eclampsia, which takes up 10 pages, and the chapter on AFE, which is double that. The final chapter on education seems incomplete in that it only talks of midwifery training and leaves the very important antenatal education of mothers to be discussed briefly in a prior chapter. Having been quite critical of the book, there are a lot of things I liked; the chapters on cardiac disease and delivery of the distressed fetus are particularly informative. However, it does not quite fulfil my expectations of being my bookshelf reference, but without a preface I'm not sure if that was the aim. It will make a useful addition to a department library, not least because it has UK authors writing about current UK practice.