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Question 726
Obstetric infection → Viral
Classification
Question
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Neuraxial anaesthesia with active chickenpox
Question Stem
A woman with chickenpox requires caesarean birth for an obstetric indication. Neuraxial anaesthesia is being considered. Which principle regarding needle placement is specifically recommended?
Options
A
Choose a site free of cutaneous chickenpox lesions
B
Insert the needle through a vesicle after antiseptic skin preparation
C
Spinal anaesthesia is mandatory because epidural anaesthesia is contraindicated
D
Epidural anaesthesia is mandatory because spinal anaesthesia is contraindicated
E
Neuraxial anaesthesia is absolutely contraindicated in every woman with chickenpox
Explanation
If epidural or spinal anaesthesia is undertaken in a woman with chickenpox, the needle should be placed through a site free of cutaneous lesions. Evidence is insufficient to define an optimum anaesthetic technique. Both spinal and epidural approaches have theoretical considerations, so the guideline does not mandate one neuraxial technique over the other.
Option Validity
B) the needle should not be placed through an active cutaneous lesion.
C) the guideline does not mandate spinal anaesthesia.
D) the guideline does not mandate epidural anaesthesia.
E) neuraxial anaesthesia is not stated to be absolutely contraindicated in all women with chickenpox.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, section 5.4.