HELLP Syndrome Anaesthesia — FRCA Final MCQ

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ModerateObstetric AnaesthesiaHELLP Syndrome AnaesthesiaFRCA Final

A 24-year-old woman at 37 weeks' gestation has HELLP syndrome. Her platelet count, confirmed 20 minutes ago, is 42 × 10^9/L, with AST 520 U/L and LDH 1200 U/L. She has no epidural catheter in situ and requires an immediate category-1 caesarean section for persistent fetal bradycardia. What is the most appropriate anaesthetic technique?

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Correct answer: C — General anaesthesia with rapid-sequence induction

General anaesthesia with rapid-sequence induction is the single best technique. The patient requires immediate delivery, has no functioning neuraxial catheter and has severe thrombocytopenia from HELLP syndrome. A platelet count of 42 × 10^9/L is well below the range in which the risk of neuraxial haematoma is considered acceptably low; HELLP may also involve rapidly changing platelet counts and haemostatic dysfunction. Therefore, spinal, combined spinal–epidural and epidural techniques are inappropriate. Local infiltration with sedation cannot reliably provide surgical anaesthesia for caesarean section. General anaesthesia requires senior help, difficult-airway preparation, control of the hypertensive response to laryngoscopy, aspiration prophylaxis and readiness for haemorrhage and blood-component support. Severe thrombocytopenia is not accurately described as an invariably absolute contraindication in every clinical context, but at this count and urgency neuraxial blockade is not defensible.

Reference: South West London and Surrey Heartlands Maternal Medicine Network. Clinical Guidance: Thrombocytopenia (ITP and GTP) in Pregnancy, Appendix 1: Care Plan Summary. Effective 2024. https://southwestlondon-surreyheartlands-maternalmedicine.nhs.uk/wp-content/uploads/2024/12/SWLSH-Clinical-Guidance-Thrombocytopenia.pdf