Labour Analgesia, Regional Techniques, and Non-Obstetric Surgery in the Parturient — WACS Viva & Clinical Scenarios (Obstetrics & Neonatal Care)

Exam-style labour analgesia, regional techniques, and non-obstetric surgery in the parturient viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 20-year-old nulliparous woman at 39 weeks gestation is in active labour (cervix 5 cm dilated). She is in severe distress from labour pain and requests an epidural. Describe the anatomy of the epidural space, the neurophysiology of labour pain across the first and second stages, and your step-by-step technique for establishing and maintaining low-dose labour epidural analgesia.
• SCENARIO 2: While performing an epidural at the L3-L4 interspace using a 16G Tuohy needle with the loss-of-resistance to saline technique, you encounter a sudden rush of clear fluid. You recognise an accidental dural puncture. How do you manage this situation immediately in the labour suite, and what is your protocol for managing the likely subsequent post-dural puncture headache?
• SCENARIO 3: Ten minutes after top-up of an epidural catheter for emergency Caesarean section with 20 mL of 0.5% plain bupivacaine, the patient complains of difficulty breathing, tingling in her fingers, difficulty speaking, and rapidly becomes unresponsive with BP 50/20 mmHg and HR 35 bpm. What has happened, and what is your immediate life-saving crisis management?
• SCENARIO 4: A 26-year-old G1P0 at 22 weeks gestation presents with acute lower quadrant pain and fever diagnosed as acute appendicitis. She is scheduled for urgent laparoscopic appendicectomy. Detail your anaesthetic considerations, drug choices regarding teratogenicity, airway management, intra-abdominal insufflation limits, and foetal monitoring strategy.