Emergency Caesarean Delivery, Obstructed Labour, Sepsis and the Difficult Obstetric Airway — WACS Viva & Clinical Scenarios (Obstetrics & Neonatal Care)

Exam-style emergency caesarean delivery, obstructed labour, sepsis and the difficult obstetric airway viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 28-year-old G2P1 at 40 weeks gestation in active labour has an artificial rupture of membranes. Immediately, loops of umbilical cord prolapse through the introitus, and the foetal heart rate drops to 65 bpm. The patient has eaten a heavy meal 2 hours ago. The obstetrician demands surgery within 10 minutes. How do you assess, choose your anaesthetic technique, and execute this Category 1 delivery safely?
• SCENARIO 2: A 22-year-old unbooked primigravida is brought from a rural maternity home after 40 hours of obstructed labour. She is febrile (39.2°C), pulse 140 bpm, BP 85/50 mmHg, dry tongue, oliguric (dark urine 10 mL/h), with foul-smelling liquor draining per vaginam. The abdomen is tender with a pathological retraction ring (Bandl's ring). Outline your pre-operative resuscitation, anaesthetic management, and intraoperative safety measures.
• SCENARIO 3: You are performing a Rapid Sequence Induction (RSI) for an emergency Caesarean section in a 35-year-old morbidly obese (BMI 44 kg/m²) parturient with full stomach status. Following administration of propofol and suxamethonium, direct laryngoscopy reveals a Cormack-Lehane Grade 4 view. A videolaryngoscope is tried, but copious secretions and pharyngeal oedema obscure the camera. SpO₂ begins falling rapidly from 98% to 75%. How do you manage this failed intubation crisis?
• SCENARIO 4: A 30-year-old G3P2 at 35 weeks gestation presents with high fever, rigors, maternal heart rate 135 bpm, BP 80/40 mmHg refractory to 1 litre bolus of crystalloid, and purulent vaginal discharge secondary to severe chorioamnionitis. Emergency Caesarean delivery is scheduled. Detail your septic shock resuscitation, choice of anaesthetic technique, vasopressor management, and post-operative critical care.