The time has come for a paradigm shift in obstetrics' medico-legal litigations.

Cerebral Palsy (CP) represents the most common neuromuscular disability in childhood and it is caused by a multiplicity of factors. Intrapartum fetal surveillance is still a controversial issue: even though intrapartum hypoxia alone plays a minimal role in causing neonatal cerebral damage, obstetricians face a large number of medical malpractice litigations for alleged birth mismanagement. The cardinal driver of CP litigation is Cardiotocography (CTG): despite its suboptimal performance in reducing the occurrence of intrapartum brain injury, its ex post interpretation is widely used to evaluate the liability of the labor ward personnel in trials and, based on this, most caregivers are convicted. This article takes cue from a recent acquittal verdict by the Italian Supreme Court of Cassation to challenge the role of intrapartum CTG as a medico-legal proof of malpractice. Because of its low specificity and poor inter- and intra-observer agreement, intrapartum CTG traces do not meet the Daubert criteria and, lastly, they should be weighed with caution in the context of a courtroom trial.

Shoulder dystocia: an Evidence-Based approach.

Shoulder Dystocia (SD) is the nightmare of obstetricians. Despite its low incidence, SD still represents a huge risk of morbidity for both the mother and fetus. Even though several studies showed the existence of both major and minor risk factors that may complicate a delivery, SD remains an unpreventable and unpredictable obstetric emergency. When it occurs, SD is difficult to manage due to the fact that there are not univocal algorithms for its management.Nevertheless, even if it is appropriately managed, SD is one of the most litigated cause in obstetrics, because it is frequently associated with permanent birth-related injuries and mother complications.All the physicians should be prepared to manage this obstetric emergency by attending periodic training, even if SD is difficult to teach for its rare occurrence and because in clinical practice it is often handled by experienced obstetricians.THE PURPOSE OF THIS STUDY IS TO REVIEW THE LITERATURE CONCERNING THE EVERLASTING PROBLEMS OF SD: identification of risk factors for the early detection of delivery at high risk of SD and a systematic management of this terrifying obstetric emergency in order to avoid the subsequent health, medico-legal and economic complications.

Nonvisualization of fetal gallbladder: a case report and review of the literature.

Failure to visualize prenatally the gallbladder at ultrasound scan may indicate different fetal malformations with a highly variable prognosis, but also a simple anatomic variable. An adequate prenatal management could help in defining diagnosis and prognosis.

Parvovirus B19 during pregnancy: a review.

Several infections in adults warrant special consideration in pregnant women given the potential fetal consequences. Among these is parvovirus B19 deserves special attention since the harmful effects on the pregnant woman and fetus. It can then cause fetal anemia, non-immune fetal hydrops and fetal death. Among cases with fetal demise, B19 is foundin significant numbers, especially in the second andthird trimesters of pregnancy. There is no specific treatment or prophylaxis available against B19 infection, but counseling of non-immune mothers and active monitoring of confirmed maternal infections with intervention to correct fetal anemia is likely to decrease mortality.

Update on systemic lupus erythematosus pregnancy.

Women with Systemic Lupus Erythematosus (SLE) still face significant risks when embarking on a pregnancy. Improvements in the field of pathophysiology, in diagnosis and a greater number of therapeutic options in the treatment of SLE, have made the medical community regard these patients with less trepidation. Despite these advances, however, the risk of significant morbidity to both the mother and the fetus still exists. THE INTERACTION OF LUPUS AND PREGNANCY IS VERY COMPLEX: the consensus is that pregnancy can worsen the lupus disease process, even if this is not predictable, and pregnancy can mimic the clinical manifestations of lupus, particularly preeclampsia/eclampsia. More specifically, pregnancy is associated in 50 to 60% of cases with a clinical flare manifesting as renalor hematological symptoms. Severe flares are uncommon (10%) and the risk of maternal death is now2 to 3%. The risk of the fetus remains high, however with increased risk of spontaneous fetal wastage and premature births, by 4.8 and 6.8 times, respectively. It is well documented that antiphospholipid syndrome and antiphospholipid antibodies are strongly associated with fetal wastage. Low-dose aspirin orheparin improves fetal outcome in these cases.Timing a pregnancy to coincide with a period of disease quiescence for at least 6 months strongly increases the chances for a healthy and uneventful pregnancy for both mother and baby. Close surveillance, with monitoring of blood pressure, proteinuria and placental blood flow by doppler studies helps the early diagnosis and treatment of complications such as preeclampsia andfoetal distress. Women with SLE frequently need treatment throughout pregnancy based on hydroxychloroquine, lowdose steroids and azathioprine. This update, based on previous available literature, should inform rheumatologists, obstetricians and neonatologists who guide patients in their reproductive decisions.