Purchased in 2018. I bought this for study purposes because I was having twins and would be undergoing a planned C-section. There weren't many books written about C-sections, and this one was detailed, so I didn't have to ask many questions at the hospital. Reading this book covered the basic knowledge of C-sections. There is some dirt on the cover, and the book has scratches on the cover and some page warping. I didn't make any notes, so the inside is clean.