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Doody's Review ServiceReviewer: Jay P. Goldsmith, MD (Tulane University School of Medicine)
Description: This is a compilation of a workshop of placentologists and other scientists on the relationship between altered placental function and neurodisability. It describes how impaired placental structure and function may contribute to abnormal fetal growth and altered brain development, the processes that lead to brain injury, and how such effects on the brain lead to disability.
Purpose: This book is intended to summarize the existing knowledge of the association between the placenta and neurodisability. The authors recognize there is still much to learn in this field and hope the book "will stimulate further investigation of this exciting and important research area." In a field that has been somewhat neglected by general medicine, this is a laudable goal and the book meets it well.
Audience: It is written for academically based research scientists and pathologists (especially those who deal with the placenta), neurologists, and perhaps other clinicians with a special interest in this area (neonatologists, obstetricians). It will be of some interest to the medical-legal community, since the debate over the importance of placental pathology has become an important issue in "brain damaged baby" cases. Except for Karin Nelson, a renowned pediatric neurologist at the NIH, and Raymond Redline, a leader in the field of placental pathology at Case-Western Reserve, all the contributors are scientists from the United Kingdom.
Features: The book starts with an introductory chapter by Dr. Nelson summarizing the evidence for the placenta playing a key role in determining neurologic outcomes in children. The subsequent nine chapters examine individual aspects of the association, including structural anomalies and lesions of the placenta, cytokine effects, the inflammatory response, growth restriction, animal models, and placental imaging. A summary chapter recapitulates much of what has already been discussed. The art is sparse, but used when needed and in color. The initial chapter and the discussion on cytokine research are outstanding summaries of where the science now stands and hint at the far-reaching medical, ethical, and economic implications of this research.
Assessment: This is the first book to discuss the complex interactions between altered placental function and neurodisability. It is written for scientists, but the implications of this area of research are far reaching. The book goes far beyond the brief allusions to this association in textbooks on the placenta or Dr. Altshuler's chapter on placental pathology and the etiology of fetal and neonatal brain injury in Fetal and Neonatal Brain Injury: Mechanisms, Management and the Risks of Practice, 3rd edition, by Stevenson, et al. (Cambridge University Press, 2003).