MacLean AB, Regan L, Carrington D, editors. Infection and Pregnancy. 394 pages, tables, figures. London: RCOG Press, 2001. ISBN 1900364 44 1. Price GBP 48.00, GBP 36.00 to Fellows, Members and Registered Trainees of the RCOG.

Abstract

The Royal College of Obstetricians and Gynecologists (RCOG) regularly convenes Study Groups to address important areas within obstetrics and gynecology. The present volume contains the edited proceedings of the 40th Study Group, complete with discussions following each section, and a set of recommendations at the end. Despite the rapid decline in maternal mortality in the western world, starting with the advent of prontosil in the mid-1930s, infections in pregnancy continue to threaten the life and health of mothers and fetuses. Globally, it is estimated that about 200 000 women die yearly from sepsis and unsafe abortion. Tourism and migration have led to the re-emergence of old threats like tuberculosis, and the appearance of malaria and other tropical diseases in unexpected places. The human immunodeficiency virus (HIV) ravages mothers and children (and fathers) in many poor countries, and such acquired immunodeficiency syndrome (AIDS)-related deaths are still on the increase in southern Africa. Infection and Pregnancy is a scholarly update on every aspect of the theme, written primarily for clinicians by a distinguished group of clinicians, epidemiologists, pathologists and microbiologists. Antenatal screening for infections is discussed, and investigation of, and exposure to, rash illness described. The next section is about new technologies for the diagnosis of infections in pregnancy, followed by a series of sections on bacterial, protozoal and viral infections, then bacterial infection and the neonate, infection and cesarean section, maternal mortality and, finally, the recommendations. One of the most encouraging advances in the field is the proven effect of specific anti-HIV therapy during pregnancy to reduce the transmission of the virus from mother to fetus. Furthermore, short and ultra-short courses are less expensive than the original ones and also practical for other reasons in the African setting. Nevirapine appears to have advantages over zidovudine. The risk of transmission through breast milk is addressed, as well as elective cesarean section as the preferred choice of delivery. Although randomized trials have shown HIV interventions to be effective, medical research into the infective causes of miscarriage is still in the Dark Ages, if the conclusion of the chapter on infection and pregnancy loss is to be believed. The recommendations for clinical practice are graded from A to C, according to the credibility of the evidence. An A requires at least one randomized trial, while a C depends on evidence from expert committee reports or opinions and/or clinical experience of respected authorities. It is a little discouraging that out of the 44 recommendations, only 10 are classified as A or B. However much expert opinions are trusted, there is certainly plenty of room for research; the Study Group participants have 22 specific suggestions. I recommend the book for individual study, meaning that it has a place on personal bookshelves, and not only in the libraries. There are references dated up to 2001; the contents will not be outdated for quite some time. The price should not be prohibitive for gynecologists or those in specialty training.