Obstetric and Gynecologic Care in Physical Therapy, ed 2.

Obstetric and Gynecologic Care in Physical Therapy, ed 2 Stephenson RG, O'Connor LJ. Thorofare, NJ 08086, Slack Inc, 2000, paperback, 352 pp, illus, ISBN: 1-55642-415-9, $35.

This book is designed as all introduction to women's health for students or clinicians with limited experience in the field. It consists of 3 sections: "Foundations for Physical Therapy Practice in Women's Health," "Role of Physical Therapy in Gynecologic Care," and "Role of Physical Therapy in Obstetric Care." The first section describes the evolution of the role of physical therapy in women's health, giving an historical perspective on the field of women's health and the ways in which the physical therapy profession in the United States has been involved in the provision of care. The second chapter in this section covers the basic science foundation for care, and it describes the anatomy of the female reproductive system and the biomechanical and physiological effects of pregnancy.

Section 2 contains a single chapter that addresses the examination, evaluation, diagnosis, prognosis, and interventions for common problems in women, including dysmenorrhea, premenstrual syndrome, acute and chronic pelvic pain, urinary dysfunction, and breast rehabilitation. The chapter concludes with the effects of aging in women and provides a succinct subsection on perimenopausal and postmenopausal issues. Charts are provided to illustrate an appropriate history and examination, and the subsections related to pathophysiology are well presented. Throughout this section, the authors suggest resources for more advanced practice. Some interventions are described in detail (eg, the subsection on dosage of electrical stimulation); other interventions (eg, management of osteoporosis) are described at a general level. The interventions described the lymphedema include the use of the pneumatic compression pump, an intervention that could be considered controversial.

Section 3 is devoted to the woman during the childbearing year, and it addresses maternal physiologic changes accompanying pregnancy, the development of the fetus, musculoskeletal problems arising during pregnancy, and the management of women with a high-risk pregnancy. This section is very strong and presents the material at an excellent level. Chapters on labor and birth and the management of labor pain include a subsection discussing how the physical therapist might assist in pain control during labor. The final chapter of this section deals with postpartum recovery and exercise programs for women who have had vaginal or cesarean births. In section 3, a chapter on physical therapy for women with high-risk pregnancies provides excellent information on cardiac disease, pregnancy-induced hypertension, arthritis, transplants, multiple sclerosis, and spinal cord injury. The references supporting this chapter are recent and view the issue from both a research and a maternal perspective. A major omission in this section, however, is the management of women who are HIV-positive and those with constitutional AIDS.

The text is supported by an excellent glossary of terms and an appendix listing product information and resources. These sections would be of great value to practitioners new to the women's health field. On balance, this book provides a sound introduction to physical therapy in women's health. The book is well organized and covers the most relevant information for entry-level practitioners in women's health. In an area of practice in which most of the available textbooks have been written for nursing or medicine, it is helpful to have a text that is directed to the physical therapist.

There are a few problems with the book, but they do not strongly detract from its utility as a basic text for entry-level practitioners. In those chapters that the authors have revised substantively or added new materials, they have done excellent research of the current literature, but references in other chapters are not always current. There is a surprising lack of updated references related to the etiology and management of back pain during pregnancy and related to exercise prescription during pregnancy, especially concerning the female athlete. In some chapters the references do not appear to have been updated for the second edition because there are few citations of books and articles published in the 1990s.

For a book published in 2000, it is regrettable that the language is not aligned with that of the Guide to Physical Therapist Practice. There are several examples of marketing flyers that would benefit from the use of the terminology recommended by the Guide. In addition to this, the case studies have a bias toward impairment-related goals that could be enhanced with a greater focus on functional outcomes.

The book will prove a valuable resource for entry-level practitioners as an introduction to women's health. The physical therapy practitioner working in the area of women's health will need to supplement the text with current research articles or texts that provide a greater depth of information on specific topics. In most instances, the major dysfunctions encountered in practice are treated at a basic level and would not be of benefit to the intermediate or advanced practitioner.

Jancis K Dennis, PT, MS Medical College of Georgia Augusta, Ga

Ms Dennis is Associate Professor in the Department of Physical Therapy where she is responsible for the women's health component of the professional curriculum.