EMQ — Extended Matching Question · Review
Question 766
Obstetric infection → Viral
Classification
Question
EEMQQuestion Header
Select the single most appropriate anaesthetic principle.
Question Stem
A woman at 37 weeks has active chickenpox complicated by pneumonia and requires urgent caesarean birth for an obstetric indication. She has vesicular lesions over part of her back. Which statement most accurately reflects the guideline?
Answer Bank
A
General anaesthesia is always the safest technique
B
Spinal anaesthesia is mandatory because viraemia contraindicates epidural anaesthesia
C
Epidural anaesthesia is proven superior to spinal anaesthesia
D
There is no evidence defining the optimum anaesthetic method; general anaesthesia may worsen respiratory compromise and any neuraxial needle site should be free of lesions
E
Any skin lesion may safely be punctured after antiseptic preparation
F
Anaesthetic technique is determined solely by fetal condition
G
Caesarean birth is contraindicated during maternal chickenpox
H
Neuraxial anaesthesia is absolutely contraindicated in all women with chickenpox
Correct Answer
D. There is no evidence defining the optimum anaesthetic method; general anaesthesia may worsen respiratory compromise and any neuraxial needle site should be free of lesions
Explanation
The guideline states that evidence is insufficient to define the optimum anaesthetic technique for caesarean birth in women with chickenpox. General anaesthesia may exacerbate respiratory compromise in varicella pneumonia. If epidural or spinal anaesthesia is undertaken, the needle should be inserted through a site free of cutaneous lesions. The guideline discusses theoretical risks of neuraxial techniques but does not establish an absolute prohibition or a proven superior technique.
Option Validity
A) General anaesthesia may worsen respiratory compromise in varicella pneumonia.
B) Spinal anaesthesia is not mandatory.
C) Epidural anaesthesia has not been proven superior; the discussion is theoretical.
E) A lesion-free needle insertion site should be selected.
F) Maternal condition and anaesthetic risks are also relevant.
G) Caesarean birth may still be required for an obstetric or maternal indication.
H) The guideline does not state an absolute contraindication to all neuraxial anaesthesia.
Further Reading
RCOG Green-top Guideline No. 13. Chickenpox in Pregnancy. Royal College of Obstetricians and Gynaecologists; January 2015, minor update 2024.