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Crises in Childbirth--Why Mothers Survive: Lessons from the confidential enquiries into maternal deaths.

Crises in Childbirth--Why Mothers Survive: Lessons from the confidential enquiries into maternal deaths. Eds D. Dob, G. Cooper, A. Holdcroft; Radcliffe Publishing; Distributor: Elsevier, 30-52 Smidmore St, Marrickville, N.S.W 2204; $89.00; 170X245 mm; pp. 224; ISBN 13: 978-1-84619049-0.

The Confidential Enquiries into Maternal Deaths (CEMD) in the United Kingdom has reviewed the deaths of mothers in pregnancy and childbirth for over 50 years, collecting valuable information and data. This has enabled it to make recommendations in its triennial reports, which have contributed to significant reductions in maternal and neonatal mortalities.

The authors of this book have reviewed these reports to identify and classify the causes of maternal mortality. The initial chapter discusses the incidence of maternal mortality and the role and impact of the

CEMD in the U.K. Experts in their fields have written chapters discussing general anaesthesia and associated intubation and aspiration, regional anaesthesia, haemorrhage, hypertension, cardiac disease, thromboembolism, amniotic fluid embolism, sepsis and intensive care.

Each chapter describes contributing factors or reasons which may lead or predispose to maternal morbidity or mortality if not recognised and treated. Case reports taken from the last 20 years of the CEMD are briefly described to illustrate such a sequence of events. Tables summarise the important factors in each case report and "Lessons" are listed. The pathophysiology and recommended management of patients with specific conditions in pregnancy are described, such as massive haemorrhage, pulmonary hypertension and cardiomyopathy.

Although the management of obstetric patients is described in numerous other textbooks, often in more detail by presenting case reports and the lessons learned from them so succinctly, this book should be read by anaesthetists, obstetricians, midwives and their trainees working in labour wards. Despite some of the case reports not being directly applicable today, such as unrecognised oesophageal intubation without end-tidal C[O.sub.2] monitoring, the chapters are easy to read and well referenced.

By combining the lessons and recommendations from decades previously with more recent and relevant ones, hopefully this text will prevent mistakes of the past from being repeated. It is highly recommended.


Melbourne, Victoria
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Author:Chester, S.
Publication:Anaesthesia and Intensive Care
Article Type:Book review
Date:Jan 1, 2008
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