O'Connor V, Kovacs G, editors. Obstetrics, Gynecology, and Women's Health. 681 pages, illustrated. Cambridge, UK: Cambridge University Press, 2003. ISBN 0-521-81893-1 hardback. Price: GBP 35.00, USD 45.00. The editors and most of the 61 other contributors to this brand-new textbook of obstetrics and gynecology come from Australia. I do not know whether this explains its novel features, but the overall impression is refreshing. Thematically, all of the traditional headlines are present, but emphasis is shifting and some new sections have been added. Whereas breast conditions in most gynecologic curricula are limited to breast feeding and mastitis, subheadings on ‘breast concerns’, ‘breast screening’, and ‘breast problems’ appear in different other chapters. In addition, there are 12 pages on breast cancer in the chapter on pre-cancer and cancer. The first part of the book is called ‘Women's health', starting with excellent advice on history taking and gynecologic examination, including examination of the pregnant uterus, not to forget the breasts. Prescription covers six pages, followed by a well-balanced discussion on the pros and contras of screening, to end with an example of how to search PubMed for evidence to help solve a given clinical problem. Ethics, minority group women (with lesbian women as one), lifestyle, body image, sexuality, abuse, and sexual assault are described in other chapters, all worthy of study. The succeeding parts follow the woman's life cycle from early (i.e. fetal, childhood, and adolescent) life through the reproductive years (including obstetrics, sexual health, subfertility, hormonal problems, and pelvic pain), the middle years (wherein menstrual problems, the menopause, pelvic floor disorders, stress urinary incontinence, pre-cancer, and cancer are covered) to the older years, where you will find osteoporosis, Alzheimer's disease, more on urinary incontinence and other conditions. Each part starts with a description of the normal, healthy situation (‘the well woman’) to continue with the various ailments. Legal issues pertaining to teenage sexuality are discussed with references to UK and Australian decisions and laws. Statistics are also mainly drawn from UK and Australian populations. The final part covers surgery including complications and adverse events, short notes on gender differences in disease, and some useful points for those who want to do research. There are chapter references and a list of abbreviations at the end, the latter covering four pages, and of course the alphabetical index. Layout is superb, tabulations and drawn illustrations are didactic. Colored photographs are presented collectively at the end of some of the sections. It is probably impossible to produce a volume of this size free of errors or inconsistencies. I found ‘caput succedaneum’ illustrated in drawings of skull bones on page 257, giving me the false impression that it is a moulding of the parietal bone instead of a swelling of the soft parts between bone and periosteum. For active management of the third stage of labor (page 263), the choice is between syntometrine and syntocinon, which are both brand names. Textbooks should preferably use generic product names. The proper name of syntocinon, oxytocin, is used on the following page. Syntometrine, a mixture of oxytocin and methyl ergometrine, is no longer in use in Denmark, Norway, and Sweden and may therefore confuse students from Scandinavia. In Table 8.5 on page 284, it is claimed that the incidence of post term pregnancy in Australia (>42 weeks) is 0.4%, which is hard to believe. In the same tabulation, birth weight less than the 3rd percentile and greater than the 97th percentile for gestational age are both said to be 2.5%, which defies logic, unless they use a foreign scale for comparison. Finally, one of the great pastimes of oncologists is to devise new classification systems for the various types of cancer. Whereas in olden days, we used to say dysplasia and carcinoma in situ of the cervix, the students are now burdened with the Papanicolaou/UK and the Bethesda terminologies, to which are added a special Australian category (pages 558–9), hopefully for the benefit of patients, but certainly not for students. The comments in the preceding paragraph are trifles. The overall impression is that of a timely, well-written and edited, textbook of obstetrics and gynecology, unreservedly to be recommended for students.
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