Medico-legal evaluation of the gynaecological consultation in cases of annulment presenting to the Ecclesiastical Tribunal of the Roman Curia in Malta

The Ecclesiastical Tribune of the Roman Curia in Malta appoints gynaecologists as medical experts to certain cases seeking annulment. These cases often essentially revolve around the confirmation or exclusion of virginity but may involve requests for other information. In this article an experienced gynaecologist and a practicing lawyer, evaluate the gynaecologist’s role, outline clinical pitfalls and offer relevant advice.peer-reviewe

Medico-Legal Litigation : the clinical contractual nature of the Obstetric Anaesthetist-Patient relationship

Once the hand-maiden of obstetrics, obstetric anaesthesia, now a fully fledged sub-speciality today provides indispensable multi-faceted services mainly but not solely to the peripartum obstetric patient. Be it in routine as well as acute obstetric work, the speciality is an integral part of the team made up of obstetrician, midwife and neonatologist. Its input ensures modern optimal care to the parturient patient and her baby.1 The anaesthetist’s unique resusucitatoy skills and critical care experience makes him/her particularly valuable, especially in high-risk patients1 as evidenced by the struggle of units lacking such a service in overcoming numerous adminsitrative, financial and logistical problems to reach this paragon of standard of care.2 By the very nature of the acutely challenging situations it deals with, this speciality is especially vulnerable to medico-legal litigation.peer-reviewe

When intra-partum electronic fetal monitoring becomes court business

Sadly but inevitably, the clinical fruit of all scientific research, like the profile of the Roman god Janus, presents us with two faces - one is patient benefit while the other is medico-legal vulnerability. As part of defensive medicine, there are situations where malpractice risk is minimised by actual elimination of certain high-risk procedures e.g. in the case of some neurosurgical operations. Intra-partum electronic fetal monitoring (IPEFM) is the commonest obstetric procedure in the developed world, producing valuable information of fetal well being as co-related to maternal uterine activity with a scope of guarding fetal well-being in labour. It is a prime example of the therapeutic/ legal liability duality which haunts modern Medicine.peer-reviewe

Maternal weight gain and fetal growth

Extrinsic factors such as maternal nutrition may affect fetal growth giving rise to short and long-term consequences. The present study sets out to explore the inter-relationship between antenatal weight gain, in part dependant on maternal nutrition, and fetal growth as determined by birth weight. The study population included 21573 women who delivered their singleton child at term during 1999-2006. This population was subdivided into 16 subgroups according to BMI and antenatal weight gain. The study confirms that irrespective of maternal BMI, there is a statistically significant trend towards low birth weight with decreasing antenatal weight gain and conversely macrosomia with increasing antenatal weight gain.peer-reviewe

History of leprosy in Malta

Leprosy was always viewed with aborrhence requiring segregation of the unfortunate sufferers. The policy of segregation in dedicated leprosaria, initially introduced during the Medieval Period, was re-adopted during the late 19th century and persisted well into the 20th century. The management of lepers in Malta followed similar principles as elsewhere.peer-reviewe

Medico-legal and obstetric challenges of recent demographic increases in Malta

The southern Mediterranean island of Malta, strategically located between North Africa and Europe and a full member of the European Union, offers an excellent European standard obstetric service. Yet, this obstetric service, like all other medical disciplines, is undergoing a severe evolutionary challenge imposed by rapid demographic shifts. It also finds itself without significant and relevant medico-legal legislation which is likely to lead to serious acute needs at the interface between the rapidly changing nature and number of foreigners residing in Malta and their medical needs, especially in the obstetric sector.The article looks at several factors, which argue for the immediate need of implementation of such legislation. One aspect of crucial importance is the demographic fact of rapidly changing profile of the patients making use of the Maltese Obstetric Service (MOS). This is the result of an influx of both EU nationals as well as irregular migrants, mostly of sub-Saharan origin. Both provide their own form of challenges to the MOS. In both, albeit more likely in the case of EU nationals, these challenges may easily find expression and resolution in eventual medico-legal action.