Abruption Emergency CS Anaesthetic Choice — FRCA Final MCQ

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HardObstetric AnaesthesiaAbruption Emergency CS Anaesthetic ChoiceFRCA Final

A 35-year-old woman (ASA I) at 32 weeks gestation develops acute abdominal pain and vaginal bleeding. Ultrasound shows retroplacental clot. CTG shows late decelerations. BP 95/60, HR 130. Diagnosis is placental abruption. What is the most appropriate anaesthetic for emergency caesarean section?

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Correct answer: B — General anaesthesia with RSI

In placental abruption with haemodynamic instability (shock) and fetal compromise, general anaesthesia with RSI is the most appropriate technique. Neuraxial techniques are relatively contraindicated because: (1) sympathetic block worsens existing hypotension, (2) abruption frequently causes DIC (neuraxial is contraindicated with coagulopathy), (3) GA onset is faster than establishing a new neuraxial block. Massive haemorrhage protocol should be activated. DIC screen (FBC, coagulation, fibrinogen) and crossmatch 6 units should be urgent priorities. Cell salvage with leucodepletion filter can be used.

Reference: RCOG – 2022 – GTG 63 Antepartum haemorrhage; OAA – 2024 – QRH: Major obstetric haemorrhage