Placenta - a silent witness: Clinical and forensic importance of placental examination

摘要: There is no doubt that obstetrics carries high medical liability risk. In many countries, gynecologists-obstetricians who attend childbirths and perform complex obstetric procedures are faced with increasing malpractice insurance premiums litigation The american College of Obstetricians Gynecologists (aCOG) publishes its survey Professional Liability since 1983, the objective to analyze effect has had on practice gynecology in United states1. according 2003 aCOG survey, 76.3% members answered questionnaire have been involved a lawsuit at least once their professional career; gynecologists/obstetricians sued total 2.64 times per individual over course careers1,2. 2006 89% respondents indicated they during careers. average number claims obstetrician was 2.6 (3). aCOG’s 2009 showed nearly 91% experienced one claim filed against them careers, an 2.69 physician. 2009, 62% percent reported were for care as opposed gynecology, same survey3,4. fetal monitoring, neurologically impaired children, neonatal death, shoulder dystocia, uterine rupture, “decision-to-incision” time identified clinical factors frequently present cases1. both surveys reasons infant (in 31% cases surveys), stillbirth/neonatal death (with 16 % delay or failure diagnosis 11% vs. 14% 2006)3,4. all surveys, neurological impair leading cause claim, cerebral palsy being most serious damage. possible etiologies discussed years, although damage neural tissue undebatable, there still agreement upon timing some authors think 90% not due intrapartum events, while opinion others devastating events occurred perinatal period5,6. It impossible firmly determine each single case whether hypoxic insult developed delivery, first few hours after birth, already before labor began, consequence long lasting hypoxia pregnancy. Careful gross histopathological examination placenta chosen can elucidate labor, help connect reconstruct disease7,8.