Obstetrics is a unique area of healthcare, in that the vast majority of situations in pregnancy and childbirth have normal outcome, even when there is no intervention from healthcare professionals. However, serious complications do occur in a smaller number of cases, and increased knowledge on their diagnosis and treatment has made a tremendous difference to maternal and fetal outcomes over the last 200 years. One could even say that obstetrics is somewhat a victim of its own success, as improvements have been so striking that much of society has erroneously perceived adverse outcomes to have disappeared and, when they occur, frequently judges them to be due to malpractice.

Progress achieved over the last decades in high-resource countries has resulted in marked decreases in maternal and perinatal mortality. In the last 80 years, maternal mortality decreased almost a 100-fold in many European countries, to values that are currently between 5 and 10 per 100,000 births. Perinatal mortality also decreased more than tenfold, to values between 3 and 10 per 1000 births. Equally important, but less well documented, is the decrease in long-term maternal and child morbidity consequent to the complications of pregnancy and childbirth.

In spite of the unquestionable success of modern obstetrical care in reducing the burden of disease associated with the reproductive process, there is still margin for improvement. According to confidential enquiries into maternal and perinatal deaths carried out over the last two decades in the United Kingdom, substandard care continues to be identified in around 50 % of cases.

Healthcare professionals working in moderate-sized European centres usually maintain experience in management of most obstetric situations by literature review and day-to-day clinical practice, but rare situations exist where lack of familiarity with the clinical entity causes apprehension and uncertainty. Some of these situations are not acute in nature, so they allow time for consultation of the literature, but others require immediate action in order to guarantee a positive outcome. These are the most feared, and sometimes even healthcare professionals with decades of experience in obstetrical care have limited practice in their management.