Contemporary Obstetrics and Gynaecology for Developing Countries

Contemporary Obstetrics and Gynaecology for Developing Countries is an interesting and valuable book that is dedicated first to Almighty God, who gave the strength to put it together; to the women, who are the major beneficiaries of the piece; and to one of the authors, Dr Rotimi Odutayo, who passed away before the book was published. This first edition is rather unique and timely, consisting of 35 chapters (16 obstetrics and 18 gynaecology). Firstly, it is the first of its kind in sub-Saharan Africa because unlike the traditional textbook of obstetrics and gynaecology in developing countries, this book includes chapters that discuss several conditions that are important to the practice of obstetrics and gynaecology everywhere but whose relevance to developing countries have hitherto not been explored. Secondly, this first edition of the book was conceived and published in 2003 by the Women's Health and Action Research Centre (WHARC), a non-governmental and non-profit organisation committed to the promotion of women' reproductive health in sub-Saharan Africa. Thirdly, this edition is edited by two distinguished obstetricians and gynaecologists and renowned reproductive health specialists, Prof. Friday Okonofua, Executive Director and Founder of WHARC, and Provost, College of Medical Sciences, University of Benin; and Dr KunleOdunsi, a Nigerian senior oncologist at the Roswell Park Cancer Institute, Buffalo, USA. The table of contents includes 35 chapters written by 39 very experienced authors who have contributed to this extensive and comprehensive book by harnessing their experience and scholarship to identify best practices based on evidence-based data. The book is a collection of up-to-date information on some of the most important areas of clinical practice relevant to developing country settings. To start with, there is a detailed section on clinical diagnosis in obstetrics and gynaecology highlighting the importance of comprehensive history, physical examination, and general and special investigations. The excellence of these chapters is complemented by other chapters that deal with ancillary diagnostic aids in obstetrics and gynaecology. Specifically of great intellectual interest are the chapters on the recent advances in gynaecological endoscopy, and the role of ultrasound in obstetrics and gynaecology. These chapters will surely inspire all but the clinically brain dead into an appreciation of good medical history, physical examination and diagnosis using these technologies. The chapters on ectopic pregnancy reminds the reader that the standard disclaimer "ectopic pregnancy cannot be excluded", which seems to be the bottomline of virtually any gynaecological ultrasound report, is an irksome reminder of the careful communication that must exist between the ultrasonographer and clinician to achieve correct clinical diagnosis and management. That each can learn from the other seems obvious and the chapter on ultrasound bridges the gap between the two disciplines admirably. With changing emphasis now shifting from hospital in-patient care towards outpatient or day case therapy, a more detailed knowledge of the ways of using ultrasound and endoscopic instruments is a way of the future for the majority in hospital practice. The chapters on gynaecological tumours, benign and malignant (GTD and cervix) and pre-malignant lesion of the lower genital tract are excellent chapters. Infertility remains a major reproductive health problem in Africa and chapter 8 dealt extensively on epidemiology, investigation and structured management. The definition of infertility should be revised to reflect contemporary definition of the inability to achieve pregnancy within 12 months of unprotected intercourse rather than 24 months. The role of assisted reproductive technologies is detailed and lucid with appropriate complementary information to the chapter on infertility. Chapter 6 on amenorrhoea is very instructive with detailed investigative procedures and clinical management. Recent advances in contraceptive development is extensively described in chapter 7. For those who have oestrogen intolerance, levonogestrel emergency contraceptive is now approved and recommended by the WHO. Indeed, contraceptive is said to be the most guarded secret among the cafeteria of contraceptives. The chapter on urogynaecology is very inspiring and gynaecologists who wish to sub-specialise in this field will find the depth of information very useful. The sub-specialty of urogynaecology, like the clinical problem of urinary incontinence itself, has been relatively little discussed and certainly under-represented on the bookshelves up to perhaps fifteen years ago. This chapter is valuable for those who need it for an understanding of the basics of urogynaecology. The need for additional research to explain racial differences in the prevalence of incontinence is a challenge to young gynaecologists. Chapter 3 on pelvic infections is well-referenced and reminds us of the implication of such infections from the point of view of morbidity and mortality. Prevention is certainly better than cure and sexuality education and promotion of abstinence may help in part to reduce the menace of pelvic infections. Abortion is an emotive and controversial subject, and in chapter 10 the author dealt extensively on spontaneous and induced abortion. Restricted abortion law is responsible for clandestine abortion leading to severe complications including death. Up to 25% of all maternal deaths in developing countries is attributed to unsafe abortion. The chapter provides an enabling understanding of preferred methods of induced abortion according to gestational age — surgical and medical. The importance of PAC and prevention of unsafe abortion were adequately highlighted. The obstetric section began with a detailed chapter on evidence-based antenatal care, followed by a very extensive and illuminating review of prenatal diagnosis and therapy. This is followed by complimentary chapters on the mechanism of normal labour and active management of labour. The chapters on premature rupture of membrane, pre-term labour and delivery and post-term pregnancy provide excellent guide, highlighting the pros and cons for management options. Fetal monitoring and surveillance in high-risk pregnancies and in labour deal comprehensively in this book with clinical and biochemical aspects such as records of the fetal heart rate and fetal ECG. It also considers the uses of real time ultrasound including the assessment of fetal breathing movements and fetal biophysical profile as well as the use of Doppler ultrasound for assessing the velocity waveform in the umbilical artery or uterine circulation. The chapter on operative vaginal delivery is a reflection on the local constraints and the socio-cultural preferences in obstructed labour with the fetus demise — embryotomy, craniotomy, decapitation are obsolete in developed countries, and symphysiotomy procedure should be in the archive of obstetrics. However, in view of our peculiar circumstances their descriptions are a grave reminder of where we are in obstetrics practice today. The chapter on HIV and concurrent infections during pregnancy in the tropics is highly commendable given the current level of HIV in Nigeria and the role of MTCT. The recommended prophylactic therapies, treatment of STDs in HIV-infected women during pregnancy and potential meditation factors for perinatal HIV transmission as well as strategies for intervention are well referenced and of value to any practicing obstetrician. Obstetric hemorrhage is a major cause of maternal mortality and morbidity and in chapter 33 there is a comprehensive discussion on the risk factors and contemporary management options in resource-poor settings. Other very useful clinical topics that are covered under the obstetrics section are malaria during pregnancy, anaemia in pregnancy including sickle cell disease in pregnancy, and hypertension in pregnancy. Some of these complications in pregnancy are responsible for adverse reproductive outcome, in particular maternal mortality and perenatalfetal loss. Maternal mortality in Nigeria is one of the highest in the world and chapter 34 dealt extensively with the causes of maternal mortality, while chapter 35 provided insight into the causes of perinatal mortality, drawing references from across the globe. On the average the maternal mortality ratio in Nigeria is about 1,000 per 100,000 live births, compared to 8-10 in the developed world. These rates give the widest disparities in terms of health and socio-economic statistics between high and low-income countries. It is likely that the stimulus for this publication is the limited number of such books from this region and the need to document recent changes in obstetrics and gynaecology from the perceptive of developing countries. The excellence of this book is instantly apparent in the clear and lucid style. Each chapter ends with an extensive list of bibliography useful for those conducting research. I enjoyed reading this book over my Easter holidays and will no doubt refer to it from time to time. Is there a place for an authoritative and comprehensive book like this? Undoubtedly, the answer is Yes! It will certainly prove useful to medical students, postgraduate students and clinicians with interest in obstetrics and gynaecology. It is inexpensive ( N 5,000), thus fulfilling some of the requirements of the students. This book will also appeal to everyone working in the field of reproductive health, be they programme staff, academicians or scholars. I recommend it to you all because of the intellectual richness of the content.