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Embryo & fetal pathology: color atlas with ultrasound correlation
  1. J-C Becher

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    Enid Gilbert-Barness, Diane Debich-Spicer. Published by Cambridge University Press, 2004, £195.00 (hardback), pp 675. ISBN 0521825296.

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    Paediatric pathology has always been a shortage specialty, but recent criticism of pathologists in the United Kingdom has led to further recruitment difficulties within the field such that many centres no longer have a dedicated specialist. Perinatal autopsy consent rates are in relentless decline throughout the world, and exposure of clinicians and pathologists to detailed examination of congenital abnormalities and disease states has become very limited. As a result there is concern that the perceived value of the perinatal autopsy among clinicians and the public is suffering.

    This atlas of perinatal pathology contains over 2000 photos and illustrations, which are a vast resource for anyone working in perinatal medicine. It coordinates information from anatomy, embryology, radiology, ultrasound, and genetics to assist in the assessment of the fetus. With over two thirds of fertilised ova resulting in non-survival and 60% of stillbirths being unexplained, the challenge for those working in obstetrics is to identify such pregnancies and pre-empt fetal loss and morbidity. To this aim, the ultrasound correlation with pathology is insubstantial, and the emphasis of this book is very much on gross pathology. Exceptions to this include a very informative section on ultrasonography describing the limitations of antenatal screening (only one third of all fetal anomalies are detected by routine screening) and the ultrasound of genitourinary abnormalities.

    From a clinician’s perspective, each chapter includes comprehensive genetics and pathogenesis of each disorder. The clear, well structured embryology section is enlightening after tedious undergraduate lectures, which have long since been bound and filed in the darker recesses of my hippocampus alongside the reproductive capabilities of the fruit fly. Although this book is lightly peppered with ultrasound images, those working in antenatal ultrasonography might appreciate the images of more common pathologies such as congenital diaphragmatic hernia and central nervous system abnormalities, as well as more recent three dimensional images. Detailed lists of investigations for particular features look helpful, but an inconsistent approach to chapter structure and headings is irritating and confusing, as are numerous errors in spelling, content, and cross references. The intended readership includes all perinatal clinicians as well as pathologists, but the autopsy chapter is confusing in its order and lacks any reference to histology.

    Of particular interest is the developmental pathology describing extremely early gestations supported by ultrasonography and the detailed cardiology specimens, which demonstrate a wide range of complex abnormalities. The value of this atlas has to be the wealth of fascinating, meticulously dissected pathology specimens and the authors’ brave endeavour to explain the pathogenesis of so many complicated conditions. In its appeal to such a broad range of specialties, this book often falls short of detail, but the message is clear: autopsy remains an important and valuable tool in both elucidating diagnoses and delineating congenital abnormality, and the continuing need for thorough and dedicated paediatric pathology services is undisputed.