The scientific literature on neonatal encephalopathy has expanded exponentially over the past few decades, and malpractice lawsuits in obstetrics and neonatology have grown to represent a significant danger to the healthcare system. Currently, scientific evidence is insufficient to definitively determine in each individual case whether the hypoxic insult formed during labour, in the early hours after birth, or otherwise whether the damage has to recognise a distant and pervasive source acting during pregnancy. In order to clearly identify all the data in favour of or against the assumption that there is a causal correlation between neonatal encephalopathy and medical misbehaviour, a more in-depth analysis of all these cases is desired, according to some authors, who believe that this scientific uncertainty leads to a higher percentage of civil suit decisions that are prone to recognising a guilty medical behaviour. This article will concentrate on the medico-legal approach to a prenatal hypoxic-ischemic incident, addressing the pertinent information that must be gathered in order to determine the medical and legal aetiology of the neonatal harm.