Book reviews

Abstract

The 4th edition of Callen’s Ultrasonography in Obstetrics and Gynecology is essentially an updating of the 3rd edition that was published in 1994. The formats of the two editions are quite similar and many of the contributing authors are the same. Most of the chapters were written by radiologists, but there are significant contributions from other disciplines interested in the use of ultrasound in obstetrics and gynecology. In this edition, most aspects of the application of ultrasound to problems in obstetrics and gynecology are presented comprehensively with extensive citation of the original literature. The obstetrics section focuses primarily on normal anatomy and the detection of fetal anomalies. Major topics such as fetal age determination and growth assessment also are reviewed, as is the use of ultrasound in the evaluation of the placenta and amniotic fluid. The assessment of fetal physiology is not addressed directly but is covered to some extent in the chapters on antepartum testing and the use of Doppler ultrasound; there is no presentation of the extensive literature on fetal behavior. The gynecology section covers ultrasound evaluation of problems involving the uterus and ovary, as well as trophoblastic disease, infertility, and ectopic pregnancy. A major strength of this new edition is the increased use of color diagrams to present embryological and anatomical concepts. Effective use of tables and figures to summarize complex clinical situations and decision-making processes also greatly enhances the usefulness of this book. The chapter on fetal syndromes and the appendix table giving the malformations associated with different medications provide important information, in a readily accessible form, that is frequently difficult to find elsewhere. The extensive correlation of ultrasound findings with those obtained with computed tomography and magnetic resonance imaging is another exceptional feature of this book, as are the chapters that deal directly with the use of these imaging modalities in obstetrics and gynecology. Despite the generally high quality of the presentations of most topics, there were some surprising omissions in the cited literature. For example, citations to the extensive work of Devore on fetal echocardiology are virtually absent in the chapter on the fetal heart, and the important publications of Chitty and Altman are omitted from the chapters on fetal age determination and growth assessment. Occasionally a subject was treated rather superficially, as seen in the chapter on fetal growth assessment. In this chapter there is no discussion of the evaluation of normal growth, no clear distinction between size (e.g., weight) and growth (change in size over time), and no presentation of the work on establishing growth rate standards. The authors focus only on fetal weight even though this parameter cannot be measured directly and its estimates are subject to significant errors and bias in some growth situations. Although over 100 weight estimation procedures are known (only 11 are presented in the appendix table), there was no discussion of how to chose a weight estimation procedure. There was a presentation of some (but not all) of the data showing that conventional methods of prenatal prediction of neonatal growth have poor outcomes. Nor is there any discussion of recent efforts to improve prenatal growth evaluations by “individualizing” or “customizing” growth assessment or by using multiple anatomical parameters. The scoring systems given are unlikely to be of much value because they are designed to detect neonates below the 10th percentile for weight. It is well known that such neonates can be normal but genetically small as well as IUGR. The difficulties associated with the correct identification of growth outcome in neonates are not discussed. Problems such as those mentioned above were relatively rare; with a few exceptions, this book provides an up-to-date, comprehensive discussion of topics that are of interest to users of ultrasound in obstetrics and gynecology. It should prove helpful to those who need current information about what can be done with ultrasound in this field.