Current Practice in Obstetrics and Gynaecology. Volume 1
Editors:
K.C. Singh, Neerja Goel, Shalini Rajaram

This book is of general interest to obstetricians and gynaecologists. It is written in the main by Indian doctors (specialists), and is similar in style to the 'Progress in Obstetrics and Gynaecology' and 'Recent Advances in Obstetrics and Gynaecology' series originating from the U.K.

The book is set apart by its inclusion of chapters on several areas of specialist interest. These so-called 'allied topics' include 'Biostatistics in Clinical Practice', 'Blood Transfusion in Obstetrics and Gynaecology', 'Breast Cancer Screening', and 'Internet Sites for Obstetrics and Gynaecology'.

The chapter on biostatistics covers concepts concerning most of the statistics commonly used in clinical studies. This will greatly assist doctors to critically review articles presented in the medical literature. Also helpful, the chapter on internet sites provides information on the quality and usefulness of each of the featured websites.

Other particularly good quality chapters include those on 'HIV and Pregnancy', 'Principles of Crisis Management in Obstetrics', and 'Choice of Hysterectomy for Benign Disease'. The HIV/pregnancy chapter provides doctors with a complete review of the clinical management of HIV-positive pregnant women. Mostly younger doctors and trainees involved in day-to-day management of obstetrics patients will benefit from reading the Crisis Management chapter. Likewise, trainees will profit from perusing the hysterectomy chapter, which helps clarify this common area of confusion.

The chapter on 'Prescribing HRT: Recent Trends' is well written, but there is lack of discussion regarding selective oestrogen receptor modulators (SERMS). Although these drugs are new and may not yet be available in many parts of the world, they appear to be very promising in the field of HRT.¹

The chapter on 'Current Status of Neoadjuvant Chemotherapy in Carcinoma of Cervix' is generally good. However, neoadjuvant chemotherapy has not really been shown to be beneficial over traditional surgery or radiotherapy in the treatment of cancer of cervix. Rather, the benefit of chemotherapy, according to promising results published recently,^2-4 is its use in conjuction with radiotherapy so-called 'concurrent chemo-radiotherapy'. Although written before this latest information became available, the chapter does include a brief discussion of this issue.

The chapter on 'Iron Deficiency Anaemia in Pregnancy' does not contain much new information. However, given the prevalence of iron deficiency in India, it is an important inclusion nonethelessd.

Prof. T. N. Leung

References

1. Mitlak BH, Cohen FJ. Selective oestrogen receptor modulators: a look ahead. Drugs 1999;57:653-663.
2. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 1999;340:1137-1143.
3. Rose PG, Bundy BN, Watkins EB, et al. Concurrent cisplatin-based adiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340:1144-1153.
4. Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage 1B cervical carcinoma. N Engl J Med 1999;340:1154-1161. e chapter

Zinc in Obstetrics Care

Zinc deficiency is common in India, and supplementation is a simple and practical solution, normal levels being attained in around 6 weeks. Zinc deficiency is of particularly great concern in the pregnant and breastfeeding mother and her infant. This is the striking impression gained from perusing this useful reference handbook designed specifically for the practising Obstetrics and Gynaecology specialist.

Women are at increased risk of zinc deficiency during pregnancy, in part because of high foetal requirements for zinc. Although a woman's requirement for zinc is very substantially increased during pregnancy, it is estimated that around 80% of pregnant women are zinc deficient. The substantial section of the handbook covering pregnancy deals in detail with the consequences of zinc deficiency in this setting which include:

• Increased maternal morbidity.
• Prolonged gestation.
• Intrauterine growth retardation of the foetus.
• Complications of labour and delivery (including inefficient labour and preterm delivery).
• Low birth weight.
• Atonic bleeding.

Zinc deficiency also affects neurobe-havioural and immunological development in the foetus/newborn.

Importantly, it is clear that there are very adverse consequences of even mild maternal zinc deficiency to both the mother and her child. For example, it is explained how even milder forms of zinc deficiency have been related to complications of labour and delivery. These complications in turn impair maternal and perinatal health, because they lead to increased risk of maternal lacerations, high blood loss, maternal infections, foetal distress, stillbirth, neonatal asphyxia, respiratory distress, and neonatal sepsis.

The requirements for zinc during lactation are even greater than during pregnancy, especially in the early weeks postpartum. Lactation poses a threat to maternal zinc homeostasis, arising from two sources:

• Increased requirement for zinc in breast milk production.
• Increased loss of zinc to the mother in the breast milk.

The section discussing lactation is divided into discussion of the importance of a positive maternal zinc balance firstly to the breastfeeding mother, and secondly, to her infant. The point is made that inadequate zinc in breastfeeding mothers is a particular concern in India.

In summary, this is a handbook full of useful information that no specialist should be without. The handbook is written in a rigorous but readable style, and carefully outlines the scientific basis for its clinical advice. For the doctor who would like to follow-up further, 30 references are cited.