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Question 197
Delivery suite → Haemorrhage
Classification
Question
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A woman at 37+2 weeks requires emergency caesarean birth for major placental abruption and persistent fetal compromise. She is receiving active resuscitation. Her blood pressure is 86/48 mmHg, platelets are 54 × 10⁹/L and coagulation studies are markedly abnormal. An epidural is not already in situ. Which factor most strongly argues against attempting regional anaesthesia?
Question Stem
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Options
A
Gestation beyond 37 weeks
B
Placental abruption as the indication for delivery
C
Maternal haemodynamic instability with significant coagulopathy
D
Persistent fetal compromise
E
Requirement for caesarean birth rather than vaginal delivery
Explanation
Regional anaesthesia may be considered in women with APH when maternal condition is stable and haemostasis is satisfactory. In this case, however, the combination of haemodynamic instability and significant coagulation abnormality materially changes the anaesthetic risk. The issue is not that placental abruption or emergency caesarean birth automatically prohibits regional anaesthesia; rather, major ongoing haemorrhage and coagulopathy make neuraxial techniques inappropriate or unsafe. Anaesthetic planning must therefore be integrated with active maternal resuscitation and the urgency of delivery.
Option Validity
A) Term gestation is not itself a contraindication to regional anaesthesia.
B) Placental abruption alone does not automatically preclude regional anaesthesia if the woman is stable and coagulation is satisfactory.
D) Fetal compromise affects urgency of delivery but is not itself the neuraxial contraindication.
E) Caesarean birth may be undertaken under regional anaesthesia in appropriate circumstances.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.