Frank Sharp - Böcker

The first few months of any pregnancy are of supreme importance to the success of that pregnancy. This statement is so obvious as to be almost a platitude, yet it must be said that no aspect of pregnancy has been more neglected in the human than the first three months. Little is known of the morphological changes that occur at that time and our knowledge of the mechanisms that control this vital stage of pregnancy is almost non-existent. The explanation for this neglect of what is an obvious area for study is the difficulty of obtaining normal material. It is rare to have material to study from a healthy first trimester pregnancy and the study by Hertig and Rock!l) of early conception found by chance in hysterectomy speci­ mens must be unique. The information that we do have about early pregnancy is mostly gained from animal studies or single miscarriages in humans. Chromosomal defects are common but are not an explanation for the majority of recurrent miscarriages. Obstetricians have hypothesised many causes for this condition and have deve­ loped numerous metQods for treating it, but the studies have been poorly con­ trolled so that our understanding of the cause(s) has not advanced. Treatment of women with a history of recurrent miscarriage by paternal leuco­ cyte infusion (immunotherapy) may be yet another form of treatment that is hailed as a new advance only to be rejected when subject to rigorous testing.

This book is based on the 20th Study Group of the Royal College of Obstetricians and Gynaecologists, which concerned the important topic of fetal growth. Basic scientific, and both obstetric and paediatric aspects of the subject were addressed in contributions from many different disciplines, and we are greatly indebted to all the international experts who took part in this workshop at the RCOG in London in November 1988. The deliberations covered the broad topics of normal fetal growth, fetal over­ growth and undergrowth. Clinical implications of these entities, especially fetal undergrowth, played a large part in the proceedings as dictated by c.1inical con­ cerns. Definitions, epidemiology, aetiology and screening were covered, as were technological developments, with special reference to blood flow and volume flow measurements, both fetal and placental. Other aspects of clinical fetal monitoring, including fetal activity measurement, and biophysical evaluation were rationalised and placed in context, and the important newly emerging areas of cordocentesis and therapy in IUGR addressed. Finally, neonatal management of the SGA baby, mortality and long-term morbidity were considered.

AIDS continually presents new questions for the obstetrician and gynecologist. These and other questions were addressed by the 19th Study Group of the Royal College of Obstetricians and Gynaecologists, whose findings are reported here.