The nuts and bolts of obstetrics and gynecology

The Physiologic Basis of Gynecology and Obstetricsedited by David B. Seifer, Philip Samuels and Douglas A. Kniss. Lippincott Williams & Wilkins, 2001. US$99.00 (xi ? 698 pages) ISBN 0683302943The Physiologic Basis of Gynecology and Obstetrics aims to describe the physiological basis for a broad realm of conditions in gynecology and obstetrics. The first four chapters present a series of important new developments. Clinicians are updated on the exciting developments and techniques in cellular and molecular biology, touching on some clinical topics. This is important for young physicians in training and even those already practicing obstetrics and gynecology with years left in their practice, because this will represent the future of clinical medicine. The chapter describing reproductive genetics reiterates some of the molecular aspects, but extends this to other molecular methods relating specifically to genetics, again eminently important for the future of medicine. The immunology of reproduction is also featured. Immunology has been perhaps the most dynamic of disciplines in the last few decades and it is essential that we become periodically updated on this topic. Cytokines and growth factors are also covered, additional areas that are often neglected but are now coming to the fore as important new additions to our understanding of physiology. Several substances are discussed, including interleukins, tumor necrosis factor, vascular endothelial growth factor and additional growth factors. These are chemical mediators that are not only of interest today, but will be essential in the foreseeable future for the management of many clinical situations.The physiological emphasis of the 30? chapters that follow is highly variable. Indeed, few present the strong physiological background of the first four chapters. Some chapters do not differ much from those in standard obstetrical or gynecological textbooks, and the physiological focus is difficult to discern. However, virtually all aspects of obstetrics and gynecology are dealt with, including some not featured in other textbooks, several of which do indeed review physiological concepts.An interesting chapter on laboratory techniques could probably have benefited from additional information to allow physicians to evaluate the quality of laboratory services. Indeed it seems that most laboratories are selected for their financial package rather than for their quality. A chapter on research design and fundamental biostatistics is also unusual for a book of this nature, and although it is not information that would be used on a day-to-day basis, it certainly broadens the base of knowledge for medical students and residents of the future. However, it is unclear where the biomedical information has come from, how it should be interpreted and how comparisons have been made. Most of the other chapters cover familiar topics: contraception, urogynecology, female reproductive aging and several aspects of maternal–fetal medicine. These are generally handled in a thorough fashion. The authors of these chapters are mostly, but not exclusively, younger researchers, and it is refreshing to see new names reviewing some of the topics with a different slant, rather than the standard doyens of our discipline rewriting the same review over and over again.I was surprised to find that some anticipated coverage was omitted. For example, although regulation of the menstrual cycle was communicated through several chapters, there was no single chapter to present a nice summary and tie everything together. I would think that, of all aspects of obstetrics and gynecology, the menstrual cycle and its regulation would be high on the list for basic physiological chapters required in such a textbook.Nevertheless, The Physiologic Basis of Gynecology and Obstetrics is an invaluable reference textbook for medical students, residents and physicians recently starting their practice, and, one hopes, would be referred to often. Although the mission of this text as a physiological primer for obstetrics and gynecology does not seem to have been fulfilled equally in all chapters, a textbook of this nature should be incorporated into the general education of medical students and residents. The cost could prohibit this, but overall, this textbook will certainly not be wasted on your shelf and is generally well-written and well-referenced so that it serves several functions, especially for the group of younger physicians.