Summary :
In previous editions of Williams Obstetrics, we have emphasized that obstetrics, originally born as a technical specialty, began to accrue scientific-based underpinnings during the last half of the 20th century. And over the past three decades, evidence-based medicine became embraced and is now firmly inculcated into clinical obstetrics. Accordingly, we again acknowledge the many fruitful efforts of the National Institute of Child Health and Human Development (NICHD) to encourage and support basic science and clinical research in obstetrical specialties. In updating this text, we relied heavily on investigations performed by members of the Maternal-Fetal Medicine Units Network. We also applaud the efforts of the American Gynecological and Obstetrical Society, the Society for Maternal-Fetal Medicine, the Society for Gynecological Investigation, and the American Board of Obstetrics and Gynecology to support the scientific and fiscal health of young clinical investigators. Evidence-based medicine can be a two-edged sword. How does the busy practitioner keep up with many innovations that seemingly appear daily into our clinical literature Who is the arbiter of their incorporation into clinical obstetrics Should observations that satisfy the mathematical definition of statistical significance, but that have limited clinical significance, be employed nationwide as the "standard of care" To us, the obvious answer is "no." And so we applaud our professional organizations such as the American College of Obstetricians and Gynecologists for their pragmatism and wisdom in recommendation of protocols for clinical management that inevitably do become the "standard." For our part, in this book we have attempted to perform a balanced review of the literature to present readers with pros and cons of different management methods so that they may select options that are best suited to their available resources. We have also tried to avoid dogmatism which unfortunately dominated the practice of obstetrics for several decades of the 20th century. At the same time, we are proud to be associated with academic teaching services that are disciplined examples of evidence-based obstetrics. Although none of these services is perfect in any sense of the definition, we draw heavily on our combined clinical observations when recommending management options. We do however emphasize that these recommendations do not necessarily represent a sole method of management. We have added new editors to further balance the breadth of obstetrics with a depth to ensure our self-imposed mandate of citing scientific underpinning of evidence-based clinical medicine. One imperative was a suitable replacement(s) for Dr. Norman Gant who needed more time as Executive Director of the American Board of Obstetrics and Gynecology. Joining us from the University of Texas Southwestern Medical Center is Dr. Steve Bloom who is director of Labor & Delivery at Parkland Hospital and who is responsible for overseeing the welfare of the more than 15,000 women who are delivered there annually. Dr. Bill Rainey is a nationally recognized scientist in reproductive and developmental biology who has made many valuable contributions to our knowledge of fetal physiology and labor initiation. Dr. George Wendel is director of the largest residency program in the country and he has also accrued an enviable reputation in the fields of obstetrical and perinatal infections, especially sexually transmitted diseases. Joining us from the University of Alabama at Birmingham, Dr. Dwight Rouse is an accomplished perinatal epidemiologist who provides depth to our myriad analyses of evidence-based outcomes. We are also fortunate to be joined by Dr. Cathy Spong from the National Institute of Child Health and Human Development who brings substantive dimension drawn from her extensive experiences accrued with the Maternal Fetal Medicine Units Network. As in the past, we have relied heavily on the expertise of many of our colleagues and hopefully we cite all of them for their scholarly contributions. Drs. Judith Head and Khurram Rehman added insight into basic science principles of fetal and placental development, perinatal physiology, and the initiation of parturition. Dr. Marlene Corton provided new illustrations for pelvic anatomy and physiology. Dr. Beverly Rogers helped with a scholarly update of the placenta and its pathology. Considerable advice for obstetrical anesthesia was given by our colleagues Drs. Don Wallace, Shiv Sharma, and Elaine Sidawi. Dr. John Schorge lent substantive insight into gestational trophoblastic disease and Drs. David Hemsell and Chuck Rolle helped to review ectopic pregnancy. Dr. Jodi Dashe was inexhaustible in her efforts to continually update citations concerning all matters genetic. And she along with Drs. Diane Twickler and Rigoberto Santos lent their considerable knowledge and experiences with ultrasonography and Doppler technology as well as with many beautiful photographs. Dr. Jim Alexander provided useful suggestions concerning the conduct of normal and abnormal labor as well as analgesia for labor. Review of information concerning contraception and sterilization was provided by Drs. Gretchen Stuart, Barry Schwarz, and Stephen Heartwell. Help with the topics of obstetrical critical care as well as imaging techniques and cerebral blood flow measurement in eclamptic women came from Dr. Gerda Zeeman who is now at the University of Groeningen in The Netherlands. Dr. Nicole Yost provided insight into gastrointestinal disorders as well as preterm birth. Dr. Brian Casey shared his considerable clinical and research expertise with diabetes and thyroid disorders complicating pregnancy. Dr. Jeanne Sheffield was immensely helpful with constant updating of recommendations from the Centers for Disease Control and Prevention for treatment of sexually transmitted diseases and other infections. It would be impossible to put together a 5000-page typed manuscript without a dedicated team to bring these efforts together. We are deeply indebted to Ms. Connie Utterback for her untiring efforts as Production Coordinator. With the help of Ms. Minnie Tregaskis, Ms. Cynthia Allen, Ms. Marsha Congleton, Ms. Kym Morris, Ms. Dina Trujillano, Ms. Ellen Watkins, as well as the late Ms. Jeanette Cogburn, who we miss greatly, the Dallas group kept the lights burning late into many nights. They were aided by Ms. Belinda Rials and Ms. Rhonda Scott in Birmingham, and Ms. Gerri Lopez in Houston. Expert artistic help was provided by Mr. Scott Bodell who had lent his talents on previous editions. Finally, we were fortunate and privileged to have the expert help of Dr. Barbara Hoffman who served as copy and rewrite editor, English and grammar tutor, and eagle-eyed proofreader who helped to keep us honest with hundreds of randomized controlled trials. These past few years have been most challenging for those of us dedicated to academic obstetrics; medical student, resident, and fellow training; and contributions to clinical and basic research. Imposition of pounds and mounds of forms and paperwork for Medicare, Medicaid, HIPAA, RRC, billing compliance, and managed care, along with major cuts in funding for health care in general, and indigent health care specifically, have required new dimensions of time taken away from clinical duties. We thus are indebted to all of those who took up the slack to allow us more time to devote to this edition. We especially cite the efforts of Drs. Barry Schwarz, Karen Bradshaw, Morris Bryant, and Robert Coleman as well as Ms. Judy Wagers and Ms. Janice Walton. This is the second edition of Williams Obstetrics for which we have been privileged to work closely with the excellent team at McGraw-Hill. Led by Ms. Andrea Seils, we thoroughly enjoyed our interactions with Ms. Karen Davis and Mr. John Williams who have been immensely helpful. Finally, we thank our families and friends for allowing us to impinge on their time to perform "book duties." We appreciate their patience and encouragement.

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