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Severe pre-eclampsia with thrombocytopenia — FRCA Final MCQ

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HardObstetric AnaesthesiaSevere pre-eclampsia with thrombocytopeniaFRCA Final

A 34-year-old woman with severe pre-eclampsia requires urgent caesarean section for deteriorating liver enzymes and fetal compromise. Platelets are 63 x 10^9/L and falling, she has epigastric pain, blood pressure 168/108 mmHg, and there is no functioning epidural. What is the most appropriate anaesthetic technique?

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Correct answer: B — General anaesthesia with senior airway and haemodynamic planning

Falling platelets at 63 x 10^9/L in severe pre-eclampsia create an unacceptable neuraxial bleeding risk for urgent surgery. General anaesthesia is therefore appropriate, with senior input, antihypertensive treatment, aspiration prophylaxis and a difficult-airway plan. Neuraxial anaesthesia is often preferred in pre-eclampsia when coagulation is satisfactory, but that is not the case here. The platelet trend is as important as the absolute value.

Reference: OAA obstetric anaesthesia guidance; Association of Anaesthetists coagulation guideline 2021