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African Journal of Reproductive Health
Women's Health and Action Research Centre
ISSN: 1118-4841
Vol. 8, Num. 1, 2004, pp. 106-108
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African Journal of Reproductive Health, Vol. 8, No. 1, April, 2004 pp.
106-108
Book Review
Contemporary Obstetrics and Gynaecology for
Developing Countries
Reviewer: Prof. O. A. Ladipo MB Bch, FRCOG, FMCOG,
FWACS, FICS
Code Number: rh04020
Editors: Friday Okonofua and Kunle Odunsi
Year of Publication: 2003
Page Extent: 683 + xix
ISBN: 978-35481-1-5 (cased)
Contemporary Obstetrics and Gynaecology for Developing
Countries is an interesting and valuable book that is dedicated first
to Almighty God, who gave the strength to put it together; to the women,
who are the major beneficiaries of the piece; and to one of the authors,
Dr Rotimi Odutayo, who passed away before the book was published. This first
edition is rather unique and timely, consisting of 35 chapters (16 obstetrics
and 18 gynaecology). Firstly, it is the first of its kind in sub-Saharan
Africa because unlike the traditional textbook of obstetrics and gynaecology
in developing countries, this book includes chapters that discuss several
conditions that are important to the practice of obstetrics and gynaecology
everywhere but whose relevance to developing countries have hitherto not
been explored.
Secondly, this first edition of the book was conceived and
published in 2003 by the Women's Health and Action Research Centre (WHARC),
a non-governmental and non-profit organisation committed to the promotion of
women' reproductive health in sub-Saharan Africa.
Thirdly, this edition is edited by two distinguished obstetricians
and gynaecologists and renowned reproductive health specialists, Prof. Friday
Okonofua, Executive Director and Founder of WHARC, and Provost, College of
Medical Sciences, University of Benin;
and Dr Kunle Odunsi, a Nigerian senior oncologist
at the Roswell Park Cancer Institute, Buffalo, USA.
The table of contents includes 35 chapters written by 39 very
experienced authors who have contributed to this extensive and comprehensive
book by harnessing their experience and scholarship to identify best practices
based on evidence-based data. The book is a collection of up-to-date information
on some of the most important areas of clinical practice relevant to developing
country settings.
To start with, there is a detailed section on clinical diagnosis
in obstetrics and gynaecology highlighting the importance of comprehensive
history, physical examination, and general and special investigations. The
excellence of these chapters is complemented by other chapters that deal with
ancillary diagnostic aids in obstetrics and gynaecology.
Specifically of great intellectual interest are the chapters
on the recent advances in gynaecological endoscopy, and the role of ultrasound
in obstetrics and gynaecology. These chapters will surely inspire all but the
clinically brain dead into an appreciation of good medical history, physical
examination and diagnosis using these technologies. The chapters on ectopic
pregnancy reminds the reader that the standard disclaimer "ectopic pregnancy
cannot be excluded", which seems
to be the bottomline of virtually any
gynaecological ultrasound report, is an irksome reminder of the
careful communication that must exist between the ultrasonographer and clinician
to achieve correct clinical diagnosis and management. That each can
learn from the other seems obvious and the chapter on
ultrasound bridges the gap between the two
disciplines admirably.
With changing emphasis now shifting from hospital in-patient
care towards outpatient or day case therapy, a more detailed knowledge of the
ways of using ultrasound and endoscopic instruments is a way of the future
for the majority in hospital practice.
The chapters on gynaecological tumours, benign and malignant
(GTD and cervix) and pre-malignant lesion of the lower genital tract are excellent
chapters.
Infertility remains a major reproductive health problem in
Africa and chapter 8 dealt extensively on epidemiology, investigation and structured
management. The definition of infertility should be revised to reflect contemporary
definition of the inability to achieve pregnancy within 12 months of unprotected
intercourse rather than 24 months. The role of assisted reproductive technologies
is detailed and lucid with appropriate complementary information to the chapter
on infertility.
Chapter 6 on amenorrhoea is very instructive with detailed
investigative procedures and clinical management.
Recent advances in contraceptive development is extensively
described in chapter 7. For those who have oestrogen intolerance, levonogestrel
emergency contraceptive is now approved and recommended by the WHO. Indeed,
contraceptive is said to be the most guarded secret among the cafeteria of
contraceptives.
The chapter on urogynaecology is very inspiring and gynaecologists
who wish to sub-specialise in this field will find the depth of information
very useful. The sub-specialty of urogynaecology, like the clinical problem
of urinary incontinence itself, has been relatively little discussed and certainly
under-represented on the bookshelves up to perhaps fifteen years ago. This
chapter is valuable for those who need it for an understanding of the basics
of urogynaecology. The need for additional research to explain racial differences
in the prevalence of incontinence is a challenge to young gynaecologists.
Chapter 3 on pelvic infections is well-referenced and reminds
us of the implication of such infections
from the point of view of morbidity and
mortality. Prevention is certainly better than cure and
sexuality education and promotion of abstinence may help
in part to reduce the menace of pelvic infections.
Abortion is an emotive and controversial subject, and in chapter
10 the author dealt extensively on spontaneous and induced abortion. Restricted
abortion law is responsible for clandestine abortion leading to severe complications
including death. Up to 25% of all maternal deaths in developing countries is
attributed to unsafe abortion. The chapter provides an enabling understanding
of preferred methods of induced abortion according to gestational age surgical
and medical. The importance of PAC and prevention of unsafe abortion were adequately
highlighted.
The obstetric section began with a detailed chapter on evidence-based
antenatal care, followed by a very extensive and illuminating review of prenatal
diagnosis and therapy. This is followed by complimentary chapters on the mechanism
of normal labour and active management of labour.
The chapters on premature rupture of membrane, pre-term labour
and delivery and post-term pregnancy provide excellent guide, highlighting
the pros and cons for management options. Fetal monitoring and surveillance
in high-risk pregnancies and in labour deal comprehensively in this book with
clinical and biochemical aspects such as records of the fetal heart rate and
fetal ECG. It also considers the uses of real time ultrasound including the
assessment of fetal breathing movements and fetal biophysical profile as well
as the use of Doppler ultrasound for assessing the velocity waveform in the
umbilical artery or uterine circulation.
The chapter on operative vaginal delivery is a reflection
on the local constraints and the socio-cultural preferences in obstructed labour
with the fetus demise embryotomy, craniotomy, decapitation are obsolete
in developed countries, and symphysiotomy procedure should be in the archive
of obstetrics. However, in view of our peculiar circumstances their descriptions
are a grave reminder of where we are in obstetrics practice today.
The chapter on HIV and concurrent infections during pregnancy
in the tropics is highly commendable given the current level of HIV in Nigeria
and the role of MTCT. The recommended prophylactic therapies, treatment of
STDs in HIV-infected women during pregnancy and potential meditation factors
for
perinatal HIV transmission as well as strategies
for intervention are well referenced and of value to
any practicing obstetrician.
Obstetric hemorrhage is a major cause of maternal mortality
and morbidity and in chapter 33 there is a comprehensive discussion on the
risk factors and contemporary management options in resource-poor settings.
Other very useful clinical topics that are covered under the
obstetrics section are malaria during pregnancy, anaemia in pregnancy including
sickle cell disease in pregnancy, and hypertension in pregnancy. Some of these
complications in pregnancy are responsible for adverse reproductive outcome,
in particular maternal mortality and perenatal fetal loss.
Maternal mortality in Nigeria is one of the highest in the
world and chapter 34 dealt extensively with the causes of maternal mortality,
while chapter 35 provided insight into the causes of perinatal mortality, drawing
references from across the globe. On the average the maternal mortality ratio
in Nigeria is about 1,000 per 100,000 live births, compared to 8-10 in the
developed world. These rates give the widest disparities in terms of health and
socio-economic
statistics between high and low-income countries.
It is likely that the stimulus for this publication is the
limited number of such books from this region and the need to document recent
changes in obstetrics and gynaecology from the perceptive of developing countries.
The excellence of this book is instantly apparent in the clear and lucid style.
Each chapter ends with an extensive list of bibliography useful for those conducting
research.
I enjoyed reading this book over my Easter holidays and will
no doubt refer to it from time to time. Is there a place for an authoritative
and comprehensive book like this? Undoubtedly, the answer is Yes! It will certainly
prove useful to medical students, postgraduate students and clinicians with
interest in obstetrics and gynaecology. It is inexpensive (N 5,000),
thus fulfilling some of the requirements of the students. This book will also
appeal to everyone working in the field of reproductive health, be they programme
staff, academicians or scholars. I recommend it to you all because of the intellectual
richness of the content.
© Women's Health and Action Research Centre 2004
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