Hypertensive Disorders of Pregnancy, Pre-eclampsia and Eclampsia — WACS Viva & Clinical Scenarios (Obstetrics & Neonatal Care)

Exam-style hypertensive disorders of pregnancy, pre-eclampsia and eclampsia viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 19-year-old unbooked primigravida at 37 weeks gestation presents to the labour ward with a blood pressure of 190/120 mmHg, 4+ proteinuria, hyperreflexia, severe frontal headache, and visual blurring. The obstetrician plans an immediate emergency Caesarean delivery for sustained foetal bradycardia. How would you prioritize and execute her anaesthetic and perioperative management?
• SCENARIO 2: A 28-year-old G2P1 at 34 weeks gestation diagnosed with severe pre-eclampsia is admitted to the delivery suite. Laboratory results show a platelet count of 48,000/mm³, AST 320 IU/L, ALT 290 IU/L, and serum creatinine 180 µmol/L. She is scheduled for urgent delivery due to non-reassuring foetal status. Detail your anaesthetic assessment, technique selection, and intraoperative haemodynamic management.
• SCENARIO 3: A 24-year-old primigravida at 39 weeks gestation suffers two generalized tonic-clonic convulsions in the triage area. On arrival, she is unresponsive (GCS 7/15), snoring, with SpO₂ 88% on room air, blood pressure 180/115 mmHg, and heart rate 130 bpm. An emergency Caesarean section is requested immediately. Outline your step-by-step resuscitation, airway management, and anaesthetic strategy.
• SCENARIO 4: A 32-year-old known chronic hypertensive G4P3 at 31 weeks gestation with superimposed pre-eclampsia develops sudden severe dyspnoea, tachypnoea (RR 38 bpm), pink frothy sputum, and bilateral coarse crackles across both lung fields following 2 litres of normal saline infusion at a peripheral health centre. The obstetric team requests immediate delivery. What is your anaesthetic plan and critical care management?