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High neuraxial block in labour — FRCA Final MCQ

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HardObstetric AnaesthesiaHigh neuraxial block in labourFRCA Final

A 25-year-old primiparous woman has a labour epidural sited uneventfully. After a 10 ml top-up for instrumental delivery she becomes unable to speak, has tingling in both hands, block to the clavicles, blood pressure 62/38 mmHg and heart rate 48/min. What is the most likely cause of the complication?

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Correct answer: B — Unrecognised intrathecal catheter migration causing high neuraxial block

A rapidly ascending block after epidural top-up with hypotension, bradycardia and upper-limb symptoms indicates high neuraxial block from intrathecal or subdural spread. Panic does not cause a high sensory level or profound sympathectomy. Amniotic fluid embolism may cause collapse and coagulopathy, but it does not explain the dense neuraxial signs after top-up. Immediate management is left uterine displacement, vasopressors, airway support and preparation for intubation.

Reference: OAA obstetric neuraxial complication guidance