Hypertension in Pregnancy

From the New England Journal of Medicine, May 29, 2003
In an era of electronic media, do hardcover monographs still have a role? I believe that works like Hypertension in Pregnancy force a reply of yes. The editors have elicited chapters from experts with long experience in research in the field and recent publications -- important criteria, if readers are to accept the opinions expressed. The numerous illustrations and tables serve well to summarize many of the topics discussed. All the authors are clearly experienced writers and use a style in which careful documentation does not bog down the text with monotony. The subjects covered range from updates on the search for the cause and pathogenesis of hypertension to practical matters, such as comparisons of different classification systems and the management of preeclampsia. These will interest physicians who are primarily responsible for the care of pregnant women as well as anesthesiologists, critical care physicians, and clinical investigators. The editors have selected respected authors to present diverse topics. Both the hypertension peculiar to pregnancy and hypertension with different causes which may coexist with pregnancy are covered. The comprehensive coverage of the systems of classification presented early in the book facilitates understanding of the subsequent chapters. Clinical investigators will be most interested in the chapters that provide up-to-date insights into the complex maze of clues about the origins and mechanisms of a disease that has frustrated them for many decades. After a number of false starts, including the use of catecholamines, corticosteroids, and eicosanoids, the evidence implicating growth factors, lipid peroxides, and microvillus membranes will provide ample food for thought. The long-recognized genetic links to preeclampsia are presented in detail in a skillful mix of epidemiology and molecular genetics. Thorough reviews of the management of preeclampsia occurring long before term and of the postpartum hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome bring the clinician up to date and provide a framework for optimal clinical care. A chapter devoted to the often overlooked subject of transient hypertension of pregnancy provides a useful reminder that this condition is not simply "pre-preeclampsia." Obstetricians and internists may make use of several chapters that provide differential diagnoses for symptoms that may either be the key to the diagnosis of a complication of preeclampsia or indicate a separate disease presenting during pregnancy. Even experienced clinicians will benefit from these checklists. Specialists in maternal-fetal medicine may be most interested in what is essentially a primer on how to perform and use maternal echocardiography in the management of preeclampsia. The preface indicates that the goal of this book is to present the recent additions to the literature. This goal has been achieved -- the references include many articles published during 2000 and 2001. Very few readers of Hypertension in Pregnancy will not learn anything new or gain greater insight into this important and intriguing disease. I intend to pass this book around to my colleagues and students, and I expect that many others will share it as well. William F. O'Brien, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Review

…up-to-date…
I intend to pass this book around to my colleagues and students.
-The New England Journal of Medicine

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