BOOK REVIEW

Abstract

Alexander Heazell, Errol R. Norwitz, Louise C. Kenny, Philip N. Baker , editors . Hypertension in Pregnancy . 208 pages . Cambridge University Press , Cambridge , 2010 . ISBN: 978-0-521-73156-0 . Price: £35.00 USD 59.00 . Hypertensive disorders complicate 5–10% of all pregnancies. Knowledge about diagnostics and management is essential to all physicians and paramedical staff working with pregnant women. This book, which has a handy format and easily goes into the pocket of the white coat, covers the different types of hypertensive disorders in pregnancy. It starts with a well written chapter providing information of normal physiological changes in pregnancy. It gives a brief introduction to the pathophysiological changes contributing to hypertension in pregnancy and goes into management more or less like clinical guidelines. Special chapters are dedicated to long-term effects on cardiovascular health and insulin resistance as well as anesthesiological concerns. The mechanisms behind the onset of hypertension in pregnancy are not fully understood and, due to their complexity, may be hard to grasp. The book provides a comprehensive description of the connection between inflammation, oxidative stress and endothelial dysfunction in preeclampsia, but in our view this does not really facilitate the understanding of these complex interactions. Perhaps more illustrations would have made understanding easier. Preexisting chronic hypertension occurs in approximately 2% of pregnancies. In about 10%, there is an underlying cause; an often neglected fact among obstetricians. The chapter about secondary hypertension covers several of these underlying conditions, the most common being renovascular disease. Some of them are very rare, such as pheochromocytoma, but they are nevertheless important to keep in mind as pregnancy is extremely hazardous in these patients. The management of severe preeclampsia and HELLP (hemolysis, elevated liver enzymes, low platelets) is challenging. In small settings, cases may be rare and the need for good clinical guidelines is obvious. This book offers a high quality review of this, based on evidence. The algorithm is easy to follow and provides a helpful aid to clinicians. The long-term effect of hypertension in pregnancy is an emerging area of interest. The book ends with describing the link between preeclampsia and the risk of cardiovascular disease. This chapter could, however, have been further developed and an inclusion of suggestions for follow-up would have been of use to the reader. Intrapartal management of women with preeclampsia and HELLP is sometimes challenging and offers difficult decisions. An extension of the discussion regarding this problem would have made this book even more useful. Due to the multiple authors, some repetition is inevitable. However, the reiterations of the definition of preeclampsia, antihypertensive treatment and the defective trophoblast invasion in preeclampsia could have been considerably reduced by more careful editing. Apart from minor lapses, the book offers a good updated complement to more extensive literature, and can be recommended to gynecologists and obstetricians, anesthesiologists, general practitioners and other professionals dealing with this group of patients.