Book Review

Clinical Obstetrical Ultrasound

William J. Ott. New York: Wiley-Liss, Inc., 1999. 394 pages in one hardback volume, illustrated, US$159.95

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, USA

Abstract

Journal of Perinatology (2002) 22, 592 doi:10.1038/sj.jp.7210673

Perhaps one of the greatest influences on the course of modern obstetrics in the latter half of the twentieth century has been the introduction of ultrasound. Since the incorporation of ultrasound into clinical practice in the 1960s, more accurate determination of gestational age, documentation of evolving structural abnormalities, and timely recognition of the fetus at risk have blossomed into new avenues of discovery and important steps in our ability to care for the unborn fetus. This ever-evolving field is fraught with controversy, as emerging concepts of both diagnosis and management are added to an already existing body of information within perinatal medicine. William Ott has undertaken the task of collating this wealth of information into a coherent volume for use as it directly relates to patient care. Clinical Obstetrical Ultrasound is designed to guide perinatologists, obstetricians, sonographers, and sonologists alike through an understanding of the clinical aspects of this large and dynamic field.

The product of a single author, this book is unified and consistent in its approach and covers the scope of topics seen in a busy high-level ultrasound practice. Beginning with gestational dating, bleeding during early pregnancy, and placenta membranes uterus, the book then proceeds in an organized fashion through anatomic organ systems. Normal anatomy is first addressed, followed by the pearls and pitfalls of diagnosing structural deformities. Pertinent discussions are included where controversy exists about the clinical significance of a particular finding. The author also includes caveats from his own clinical practice and tables of data from his years of ultrasound experience. The book then addresses more clinically directed topics such as altered fetal growth, amniotic fluid volume, antepartum fetal surveillance, and multiple gestation, ending with an excellent chapter on chromosomal abnormalities. A 31-page appendix contains growth charts for varying anatomic measurements, including such specific variables as nose width and chin length.

A unique bonus to this book is the inclusion of a CD-ROM inside the back cover. This disk can be run on any PC Pentium processor with Windows 95 or higher, 12 MB Ram, 5 MB hard drive space, a sound card, and CD-ROM drive. Created in Macromedia Director, the disk includes an interactive menu with the author's own lecture slides, still pictures of anomalies, tutorials, and live-action scanning. A graph folder is also included, containing printable graphs for fluid, measurements, and growth. Technical support is available, although the disk is fairly self-explanatory.

The task of organizing this volume of information by one individual is itself remarkable. The author's expertise in the field is clearly shown by the clarity with which he presents the topics while recognizing the clinical relevance of new data and nuances of diagnosis. However, in many of the discussions of specific anomalies, prognostic and obstetrical/neonatal management issues are not addressed. Gastroschisis, for example, is discussed primarily in terms of ultrasound appearance and associations, with essentially no reference to delivery mode or long-term neonatal outcome. Although this approach is useful for diagnostics, it limits its ability to guide perinatal management. Furthermore, the technical quality of the figures in this book is less than expected for the obviously excellent images that were taken. The grainy quality suggests that many figures were enlarged, and the on-image labeling appears computer generated, which can be distracting to read.

Despite these shortcomings, this book is actually well organized and easily readable. The extensive appendix makes this a useful reference for the ultrasound room. The logical approach to topics commonly encountered in practice will be especially helpful to the practitioner. The added bonus of a CD-ROM makes this actually two references in one.

October/November 2002, Volume 22, Number 7, Pages 592-592

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