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Congenital intrauterine infections.

Congenital intrauterine infections, Deepika Deka, editor (Jay Pee Medical Publishers, New Delhi) 2010. 283 pages. Price: Rs.495.00

This is a multi-author book on various aspects of congenital intrauterine infections. It has been divided into five sections--Maternal fetal sequelae, Problem-based approach to maternal-fetal management, Prenatal diagnosis of congenital infection, Consensus opinion, and Illustrative cases.

It is innovative that the book expels misconceptions right at the outset in the first chapter. These misconceptions have existed for a long time for unknown reasons. The chapter 'Outcome of neonates born with congenital infections' covers TORCH infections quite comprehensively. It would have been wonderful if the outcome in presence of other congenital infections had also been covered. Three important aspects have been covered in the subsequent three chapters: mental retardation, ocular manifestations and hearing loss. These chapters have been written and illustrated well by respective specialists, and are quite informative. The chapter 'Effects of genital tract infections and pregnancy outcome' categorizes the outcome clearly, but has a misleading title. It covers different infections like bacterial vaginosis, trichomoniasis, gonorrhea, Chlamydia trachomatis, and genital warts detailing aetiology, pathogenesis, diagnosis and treatment, instead of concentrating on just the effects as the title suggests. It is not clear why urinary tract infections are included in this chapter, because the urinary tract is distinct from the genital tract. It does not include some important genital tract infections like syphilis and candidiasis, which would have made the chapter more comprehensive.

Chapter 7 is on avidity-testing to pinpoint timing of maternal infections during pregnancy. It is quite informative. It might have been included in section three, after chapter 18 on conventional laboratory diagnostic techniques. The remaining chapters in this section are devoted to the treatment of TORCH infections, Parvovirus B19 infection, chickenpox, measles, mumps, tuberculosis, hepatitis, HIV, and some sexually transmitted infections. These are all quite serious problems for the pregnant women as well as their obstetricians. Perhaps for this reason these chapters have been grouped together under the heading: 'Problem-based approach to maternal-fetal management'. The topics have been covered well. The chapter on HIV is written with precision and is very informative. The chapter on tuberculosis is comprehensive. It would have been better if it had included information on the problem of exposure to teratogenic anti-tuberculous drugs during the first trimester inadvertently or through lack of adequate care in contraceptive counselling of patients being prescribed anti-tuberculous therapy. This is not an uncommon problem, and its management can be quite challenging. The chapter on hepatitis in pregnancy is precise and informative.

Chapter 18 is on laboratory techniques for prenatal diagnosis. It describes diagnosis of TORCH infections well. However, the remaining infections have not been covered in this chapter, nor in any other chapter in this section. It would have been better to combine all together instead of scattering them all over the book in different chapters. The chapter on the role of ultrasound in prenatal diagnosis of congenital infections is quite extensive and well illustrated. It should prove very useful to an obstetrician, a sonologist and an interventionist. In addition, there is one whole chapter devoted to ultrasound guided procedures in prenatal diagnosis of congenital infections. It describes need for procedures like amniocentesis, foetal blood sampling and chorion villus biopsy. The techniques of performing these procedures have also been described.

In the section on consensus opinion, there are screening guidelines for intrauterine infections during pregnancy. It covers TORCH infections, syphilis and hepatitis B. Unfortunately it does not deal with HIV, which is of a great concern to all healthcare workers and pregnant women.

The chapter 'Impact of health education and counselling in prevention of congenital infections' is very important and useful. A large number of infections in pregnancy are either missed or diagnosed very late, so that the foetus is likely to be already damaged when the presence of any of these infections is detected. Many of the infections do not have satisfactory treatment. If the women are taught preventive measures, the outcome of the pregnancies will be far superior to that after using different diagnostic tests and giving different forms of treatment.

It is a multiauthor book, which ensures that it includes a lot more information than would have possible had the book been written by a single author. It must be mentioned in passing that designations of some contributors are not mentioned in the contributor list. Another advantage of it being a multiauthor book is that one gets to read a lot of writing styles, which breaks the monotony of a single style of a singleauthor book.

The book is printed on glossy paper. The print is in two colours--black and blue--which makes it more attractive. Text boxes with faint blue background shade highlight important text. Some of the colour plates are very good. The topics are arranged with a scheme different from conventional organization based on diseases covered in a textbook manner. As a result, the information on a given disease is often scattered in different parts of the book and the reader has no immediate access to all information on a given disease but has to search for it. It is possible to do so using the index, but not very convenient. There are two other disadvantages of this arrangement of topics. There is an unavoidable overlap between different chapters and duplication of information. It would have been wonderful to have more recent journal references. Overall the book should prove useful to medical students and consultants.

S.V. Parulekar

Obstetrics & Gynecology

Seth G.S. Medical College

K.E.M. Hospital

Mumbai 400 012, India
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Author:Parulekar, S.V.
Publication:Indian Journal of Medical Research
Article Type:Book review
Date:Apr 1, 2011
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