Obstetric Anesthesia and Uncommon Disorders. Edited by David R. Gambling and M. Joanne Douglas. Philadelphia, W.B. Saunders Company, 1997. Pages: 479. Price:$89.00.

Everyone who is involved in the practice of obstetric anesthesia will face challenges of the gravid patient presenting with an uncommon medical disorder. With advances in antenatal care and reproduction endocrinology, patients with coexisting diseases will present in labor and delivery. Occasionally, they present without warning and require some form of emergency treatment for delivery. Drs. Gambling and Douglas have put together an excellent review for such occasions in this first comprehensive textbook of anesthesia for obstetric patients with uncommon diseases.

The diversity of the topics discussed in this textbook is of particular interest to anesthesiologists. However, obstetricians and maternal fetal medicine specialists will also benefit from this textbook because it clearly explains the anesthesia implications for their difficult patients. The chapters are thoughtful and very well laid out, with a common-sense approach to the anesthesia management of these are disorders. The strengths of the textbook are in its ease of reading and the substance of its chapters, enabling the reader to make an informed choice.

The first part of the textbook concentrates on cardiac, respiratory, and neurologic diseases, and the remaining chapters deal with the more rare metabolic, endocrine, and hematologic disorders. The text also includes a very useful chapter concerning unusual maternal and fetal conditions, which summarizes some of the treatment dilemmas in patients undergoing rare procedures, such as cordocentesis. We particularly enjoyed the chapters concerning cardiac abnormalities in the gravid patient, because there are excellent illustrations of the various repairs for congenital heart diseases with the physiologic changes explained. This is particularly helpful because the number of patients with congenital cardiac disease is increasing in our patient population.

Overall, this multiauthored textbook is very well written and comprehensive. The figures and tables have been appropriately selected and effectively illustrate some of the important points in the text. This textbook adequately discusses most of the uncommon diseases that one would see in a moderate-sized obstetric anesthesia practice. For tertiary referral centers this book is an invaluable resource. The hard-bound version of this book lends it to be particularly useful as a reference book to be placed on site in delivery units and departmental libraries. This is an excellent-value-for-money textbook for all anesthesiologists interested in obstetric anesthesia, and a must for all those practicing high-risk obstetrics with a teaching commitment. Similar to Anesthesia and Co-existing Diseases, edited by Drs. R. K. Stoelting and S. F. Dierdoff, this text will need to be updated as the frontiers of medicine move on.

Gary M.S. Vasdev, M.B.B.S.

Director, Obstetric Anesthesia

Edwin H. Rho, M.D.

Fellow, Obstetric Anesthesia; Department of Anesthesiology; Mayo Clinic; Rochester, Minnesota 55905;vasdev.gurinder@mayo.edu

(Accepted for publication October 13, 1998.)