Your Developing Baby, Conception to Birth: Witnessing the Miraculous 9-Month Journey by Peter M. Doubilet, MD, PhD, and Carol B. Benson, MD, with Roanne Weisman, McGraw-Hill, New York, 2008. 186 pages

Your Developing Baby is written for prospective parents, grandparents-to-be, or anyone interested in a visual guide of fetal life from conception to birth. The medical authors are 2 radiologists who specialize in obstetrical ultrasound at Brigham & Women's Hospital in Boston and happen to be a married couple with 5 grown children. They draw on both personal and professional experience and sought to help answer the questions many patients ask during pregnancy about their fetus' growth and development. They emphasize the fetus as a patient and hope this book helps parents get to know their baby before delivery. This book discusses and displays pictures from 2-dimensional (2D) and 3D ultrasounds, color Doppler scans, and Doppler velocemitry, and uses excellent labeled drawings with the images to aid in identification.

The book is divided into 6 parts with 15 chapters. The first part is 2 chapters with an overview of milestones in pregnancy and how a woman's body prepares for pregnancy. Part 2 is about fetal life in the first trimester, and part 3 includes second- and third-trimester growth and development. Part 4 addresses multiple gestations, with part 5 describing placenta, cord, and amniotic fluid with specific testing and management options available. Part 6 is about labor and the birth process. There is an appendix that describes the procedure and use for each mode of ultrasound displayed in the book.

Chapter 1 gives the reader some definitions of terms used in obstetric care and throughout the book the authors are careful to define and/or remind readers of what terms mean as they are used. This chapter is an overview of some milestones in fetal development seen with ultrasound imaging. The second chapter is about the menstrual cycle and the basics of ovulation and fertilization using diagrams and US images of ovaries showing follicular cysts.

In part 2, chapter 3 discusses conception, implantation, and cell division of the embryo with ultrasound pictures of gestational sac at 5 weeks' gestation, fetal pole, and images showing fetal growth in the first trimester. Chapter 4 emphasizes the switch from creation to tissue growth and from structures to the function of specific tissues, including bone formation and the establishment of nutritional support with circulation through the placenta and cord.

Part 3 includes growth and development during the second and third trimesters. The first chapter's focus is on the head with a display of 3D images of fetal faces and the 2D views of inside the head with development of the structures of the brain over time. Chapter 6 covers the chest, abdomen, and spine. The importance of fetal breathing movements and lung maturation tests is stressed. Examples of the heart structures with diagrams are given, and the fetal to adult circulation process is described. The abdominal organs and their functions are described, and a color flow Doppler study shows blood flow in the cord vessels. The spine section includes an explanation of the gradual process of ossification of the spinal column and ribs. Chapter 7 is devoted to the developing arms and legs, again with nice pictures of both 3D external surfaces and the 2D internal structures, with good finger details shown. The authors explain the importance of fetal movements and fetal sleep/wake patterns.

The next chapter describes the developing sexual organs of the early fetus to the differentiation of female and male structures and how each is determined by what is seen on ultrasound, including urination into the amniotic fluid with pictures. Chapter 9 goes over the correlation between size and gestational age and the accuracy of dating especially in early gestation. They describe and show with images what structures are measured and which are used to determine normal or abnormal fetal growth.

Part 4 addresses multiple gestations, starting with a chapter on twins, which describes nicely the identification and importance of establishing zygocity, amnionicity, and chorionicity by ultrasound with images and diagrams. Next is a short chapter on triplets and high-order multiples, with a few pictures of early ultrasounds of triplets and quadruplets.

Part 5 includes 2 chapters, 1 about the placental structure, position, and function, including cord blood flow with color Doppler images and umbilical artery waveforms and amniotic fluid dynamics. The other covers testing on amniotic fluid, chorionic villous sampling, and umbilical cord blood sampling, using good ultrasound images with diagrams beside them to show how each procedure is done.

Chapter 14, "Preventing Problems: Knowledge Is Power," uses fictional case stories to illustrate some of the types of problems that can be picked up using ultrasound. These include ectopic pregnancy, fetal heart defects, fetal hydronephrosis, uterine-placental insufficiency, hereditary genetic disorders, and Rh sensitization. All of the cases have relatively good outcomes, but the authors stress that some conditions can be treated and/or managed differently when diagnosed. If no treatment is available or possible, then knowledge of a condition can prepare the parents emotionally and/or obtain appropriate follow-up care for the infant.

Part 6 is on labor and birth and most of it is described by an obstetrician who delivered twins herself at the authors' institution, although somewhat personal, it does include some ultrasound images and diagrams of cervical dilatation and effacement.

Overall this book does a very good job of describing and explaining structures and functions of fetal anatomy in terms that the general public can understand. Moreover, the images with their corresponding diagrams are excellent in allowing those who are not familiar with US images to "see" what is pictured. They also use good comparisons and examples to illustrate what is medically complicated. They note that all images in the book were products of medically indicated procedures and describe the difference in what information is obtained with 2D versus 3D ultrasound. While I am not a fan of using the terms that the baby looks "normal" or that a baby can be determined "healthy" by ultrasound, when you really mean there is no evidence by US of deformity or nothing to alert one to a potential genetic abnormality, these terms are used sparingly in the book and the authors may think it appropriate for their target audience. The authors note that while they have authored many scientific and medical articles, this is their first book for general readers and they have achieved their goal of making fetal development understandable with this "visual tour guide."

Dawn E. Collins, RNC, RDMS, JD

Attorney Department Editor, Legally Speaking, Contemporary Ob/Gyn, 41 Rivo Alto Canal, Long Beach, CA 90803, E-mail: [email protected]