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Placenta praevia with morbid obesity — FRCA Final MCQ

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HardObstetric AnaesthesiaPlacenta praevia with morbid obesityFRCA Final

A 37-year-old woman with BMI 52 and placenta praevia is booked for elective caesarean section. Airway assessment suggests difficult mask ventilation, ultrasound shows an anterior placenta, and the obstetrician anticipates major haemorrhage. She has no contraindication to neuraxial anaesthesia. What is the most appropriate anaesthetic technique?

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Correct answer: D — Planned neuraxial anaesthesia with senior multidisciplinary preparation for conversion

For high-risk obstetric surgery, planned neuraxial anaesthesia is often preferred when feasible, but preparation must include senior anaesthetic, obstetric and haemorrhage planning with a robust conversion strategy. Routine general anaesthesia in a patient with BMI 52 and difficult airway predictors increases maternal airway risk. A first-generation supraglottic airway is inappropriate for elective high-risk caesarean delivery. The plan should include positioning, aspiration prophylaxis, blood availability and difficult-airway equipment.

Reference: OAA obstetric anaesthesia guidance; RCoA GPAS obstetric anaesthesia standards