The Yearbook of Obstetrics and Gynaecology, Volume 10Editors: DavidSturdee, KarlOlah, DavidPurdie, DeclanKeane400 pp Price £48 ISBN 1-900364-72-7London: RCOG Press, 2003
Authors: Laurie Mongomery Irvine
Journal: Journal of the Royal Society of Medicine (2003)

It may seem strange that, in an age of high technology, a key topic in obstetrics and gynaecology should be the use of a few centimetres of synthetic tape to support the urethra. Tension-free vaginal tape (TVT), which has only recently gained popularity in the UK though long used in Continental Europe, is awarded a whole chapter in the 2003 Yearbook of Obstetrics and Gynaecology. In this operation for genuine stress incontinence, a vertical incision is made in the anterior wall of the vagina and the tape is inserted to both sides of the urethra and out through two small lateral incisions just above the pubic symphysis. The operation is tension free in that the ends of the tape are not sutured. The long-term success rate with this procedure approaches 80%—about the same as that of the colposuspension and sling operation, but with shorter hospital stays and lower morbidity. It is thought to work by kinking of the mid portion of the urethra rather than bladder neck elevation (the mechanism with colposuspension). Complications are usually minor, although vascular damage and even deaths have been reported: urgent laparotomy is required if large vessel damage is suspected. The technique does not usually require general anaesthesia, and the low-tech equipment means that it is applicable in developing as well as developed countries. With the increasing use of TVT, more women will be cured of the common and distressing condition of genuine stress incontinence.

Every chapter in this year's volume is instructive, but let me mention some others that especially caught my interest. Anyone involved with obstetric and labour ward care will appreciate the discussion of cerebral palsy and the new ideas on its aetiology. A widespread belief (fuelled by court cases) that the brain damage occurs during labour—through hypoxia, acidosis or other insults—rather than antenatally, has led to a climate of anxiety in obstetrics, with increasing intervention rates. The chapter makes clear that cerebral palsy is a spectrum of conditions caused by an interplay of factors including extreme prematurity, chorioamnionitis, inborn errors of metabolism and inherited thrombophilias. Postnatal factors may include the use of corticosteroids and hypocapnia from mechanical ventilation. This chapter deals well with a subject poorly covered by some textbooks. Another burning issue is the increasing trend towards elective caesarean section in the UK. For many doctors, it is hard to see why any woman should choose an elective section when there is no 'obstetric' indication. The chapter evaluates recent publications on the risks for mother and baby, and the facts therein will be a helpful resource for clinicians in what can sometimes be a challenging consultation.

Though written primarily for obstetricians and gynaecologists, there is much in this yearbook that will interest neonatologists, paediatricians, urologists, endocrinologists and microbiologists—and, indeed, anyone who offers care to women and children.