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Prenatal care. Effectiveness and implementation.
  1. JOHN McGARRY, Consultant Obstetrician and Gynaecologist in Independent Practice North Devon

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Prenatal care. Effectiveness and implementation. Edited by Marie C McCormick and Joanna E Siegel [Pp363; £39.95] Cambridge University Press, 1999. ISBN 0-521-66196-X.

After fifty years, my only real memory of the paediatrics teaching of Professor A V Neale in Bristol is the benefit to children of sunlight and the aphorism “Preconceptual and Prenatal care is crippled by a large proportion of the disadvantaged population who further disadvantage themselves by their own actions”. Regrettably this text from the USA shows us that little has changed. Over these decades the rate of prematurity, intrauterine growth retardation (IUGR) and perinatal mortality has changed very little in spite of all our collective clinical efforts.

The male partner is hardly mentioned in this book so it seems that, to American eyes, the sole responsibility for producing healthy or unhealthy babies lies with the mother. All of us now know that many varied vaginal infections are associated with premature/pre-labour rupture of the membranes and prematurity itself and that antibiotic treatment may have a reducing effect on these problems. Yet with a close reading of the chapter on vaginal infections, which is very well referenced, there appear to be no papers indicating that with all these infections possibly being sexually transmitted, no trials have included investigation and treatment of the male partner. For example, although Bacterial Vaginosis, Candida and Haemolytic Streptococcus are not usually recognised as sexually transmitted diseases (STD), all gynaecologists have witnessed cases where they have been the cause of recurrent vaginal infections.

Many chapters emphasise the adverse effects of alcohol, smoking, recreation drugs and poverty on the unborn fetus. I have always had a healthily sceptical interest in Jongbloet's1 theory that alcohol consumption just before and at the time of conception may be responsible for a large number of chromosomal aberrations but this attractive theory is nowhere to be found in the book.

Meanwhile we are beset by new threats. A recent study,2not mentioned in this book, shows ecstasy exposure being implicated in some congenital anomalies.

This is a well researched book with excellent references. Throughout, areas of research yet to be carried out are mentioned. For that reason alone it could serve as a good “ideas” source book for junior paediatricians and obstetricians to involve themselves in research projects which may one day help to reduce the continuing high incidence of potentially-damaged babies.