I. H. Porter and E.B. Hook, eds. HUMAN EMBRYONIC AND FETAL DEATH New York: Academic Press, 1981 $27.00
This book reports the proceedings of the Tenth Annual Birth Defects Institute symposium, held in Albany, New York, in October, 1979. The book is an analytical review of various aspects of loss with little emphasis on management.
Prenatal mortality in experimental animals and nonhuman primates is examined in two chapters. An interesting section deals with genetic causes of fetal wastage in mice. The Central Laboratory of Human Embryology, University of Washington, provides some interesting and useful data resulting from the painstaking examination of a large number of unselected spontaneous abortions. It is quite clear that the incidence of spontaneous abortions, both chromosomally normal and abnormal, increases as maternal age exceeds 35 years. Environmental factors are covered in several chapters and include possible occupational hazards (for which more studies are needed), infections, and radiation during pregnancy. The outcome of the Dutch war-famine and the effects of supplemental diets in a New York City study are included in a chapter analyzing possible dietary etiologies. Particularly, ethanol consumption, and also smoking, appear to show a relationship to fetal loss.
Two excellent chapters deal with chromosome abnormalities, known to occur in about 50 percent of recognized fetal deaths. One chapter analyzes these according to type, maternal age and socioeconomic level; the second attempts to identify the source of these abnormalities, concluding that 92 percent of trisomies in spontaneous abortions result from maternal meiotic errors. Triploidy, seen in 16 percent of chromosomally-abnormal abortions, usually results from double fertilization of the egg. There is a helpful chapter on genetic counselling for couples with reproductive loss. The editors include some very useful tables on spontaneous fetal death rates byyear, maternal age, race and gestational period. In addition, Dr. Warkany provides a delightful historical note concerning malformations.
At $27.00, the book is reasonably priced and well-produced. It contains a lot of useful information under one cover. It could be a useful addition for certain pediatricians who care for and advise families with congenital malformations; although the subject is spontaneous abortion, there is a continuum from fetal loss to developmental defects. Early education concerning the effects of alcohol, smoking, etc. on pregnancy outcomes also involve the pediatrician.