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Fetal therapy. Invasive and transplacental.
  1. MARK KILBY
  1. Department of Fetal Medicine
  2. Birmingham Maternity Hospital

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    Fetal therapy. Invasive and transplacental. Edited by Nicholas Fisk and Kenneth Moise. (Pp 369;£70 hardback). CUP,1997. ISBN 0-531-46133-2

    This book brings together several expert “reviews” from the field of fetal therapy, mostly drawn from those who lecture on the advance course in fetal medicine at Queen Charlotte’s Hospital, London. The book’s editors are both leading figures in fetal medicine.

    The text deals with this rapidly expanding area, which, despite an exponential increase in knowledge over the past 10 to 15 years, is still a relatively new specialty.

    The book is divided into five sections which makes it easy to digest. I enjoyed the chapters on multifetal pregnancy reduction, fetal infection, and feto–fetal transfusion. The chapter on open fetal surgery, although describing data which are still revolutionary, was presented in a rather tired way. Indeed, this section has changed little over the past few years, and is similar to chapters in other books.

    As well as established invasive and transplacental methods of fetal therapy, which are comprehensively and meticulously covered, discussions on open and endoscopic fetal surgery are also provided within chapters. Generally, these are balanced and the authors’ enthusiasm tempered by caution and a call for a better understanding of pathogenesis and registers to monitor fetal and maternal outcome. The chapter on fetal goitre and thyroid function is interesting and I cannot recall a similar review in other texts.

    The section on future developments is of general interest, embracing both stem cell transplantation and gene therapy. Data are presented in terms of applied basic science research and anecdotal treatment in humans. Again, balanced views are put forward and possible potential problems of such treatment discussed.

    Refreshingly, and importantly, Frank Chervanak’s review of the ethics of fetal therapy is comprehensive. Such a review should be mandatory reading for any subspecialist involved in this field.

    This book will be of interest to trained fetal medicine physicians, those in training posts, and will appeal to such individuals on both sides of the Atlantic. It will also be of general interest to those professions that interface with fetal medicine, such as neonatal paediatrics, paediatric surgery, and genetics. Despite the relatively small number of fetal medicine specialists and trainees in the UK, the appeal of such a text is universal.

    The rapid and continued expansion of fetal medicine will perhaps give this text a limited shelf life.

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