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Gynaecology (4th edn)
  1. Gillian Robinson
  1. Associate Specialist, Department of Sexual Health, Southwark Primary Care Trust, London, UK

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Gynaecology (4th edn) Robert Shaw, David Luesley, Ash Monga (eds). Oxford, UK: Churchill Livingstone (Elsevier), 2010. ISBN-13: 978-0-70203-120-5. Price: £165.00. Pages: 1096 (hardback)

This is the fourth edition of Gynaecology, which has become one of the standard textbooks of the specialty. It is a large tome and seems to weigh considerably more than my own well-thumbed second edition! A quick count reveals 100 more pages.

This edition has two new editors, both experts and subspecialists in their field: Professor David Luesley has edited the Gynaecology Oncology section and Mr Ash Monga the one on Urogynaecology. The editors hope that this new edition will look forward to the challenges of the 21st century, updating readers on all major advances since the previous edition was published in 2003. The editors claim that the book will serve as a comprehensive text for the established specialist and a resource for trainees preparing for examinations as well as general practitioners.

The book comprises five sections: Basic Principles and Investigations, Reproductive Medicine, Benign and Malignant Tumours, Urogynaecology and Women's Reproductive Health. Overall this is a good book; the chapters are well written, informative and up to date. The illustrations and diagrams are excellent. Each chapter is self-contained and can be read without reference to the others. I imagine that few readers will do as I did and read the book from cover to cover; in doing so it became apparent that there is considerable overlap between some chapters, especially in the Reproductive Medicine section. This section is also the largest and I suspect it could be edited without detriment. Despite the size of this section I was surprised that the chapter on menopause was not longer. Some details on management would have been helpful. The two chapters on sexual dysfunction could be merged.

I was disappointed that where contraception and sexually transmitted infections were mentioned, outside the chapters dealing directly with the topics, the guidance was at variance with that given by the Faculty of Sexual and Reproductive Healthcare (FSRH) and the British Association for Sexual Health and HIV (BASHH) and at times was incorrect. In the chapter on preoperative care, Gillick competence was discussed with no acknowledgement of Lord Fraser. The venous thromboembolism (VTE) risks used old figures and there was more emphasis on second- and third-generation progestogens than is given today. The chapter on endometriosis suggested using high-dose combined oral contraceptives for treatment, which was acceptable even with a personal or family history of VTE (after a coagulation screen). In another chapter the Progestosert® and Mirena® were considered to be the same device. The recommended treatment for pelvic inflammatory disease did not follow the (admittedly different) advice from the Royal College of Obstetricians and Gynaecologists or BASHH and suggested removal of an intrauterine device (not FSRH guidance!). These may appear small points to a general gynaecologist but as I work in the field of reproductive and sexual health they were irritating and detracted from an otherwise excellent work.

I enjoyed reading the book and updating my knowledge. It would be wrong to single out any particular chapter because they were all good. It was useful that chapters on breast disease (benign and malignant), lower intestinal disease and lesbian and bisexual health issues were included.

I recommend this book and think it will be a useful addition to both home and clinic bookshelves. I suspect it will not remain in pristine condition for long! However, community practitioners will look in vain for advice about some of the most common gynaecological problems presenting to our clinics; for example, there is no mention of the management of either postcoital or intermenstrual bleeding.

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