Medical Co-morbidities in Pregnancy and Maternal Critical Illness — WACS Viva & Clinical Scenarios (Obstetrics & Neonatal Care)

Exam-style medical co-morbidities in pregnancy and maternal critical illness viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 24-year-old G2P1 at 36 weeks gestation with known severe rheumatic mitral stenosis (mitral valve area 0.9 cm², resting mean gradient 14 mmHg) presents in early labour. Her pulse rate is 115 bpm (irregularly irregular), BP 100/60 mmHg, SpO₂ 94% on room air, with bibasal fine crackles. The obstetrician recommends an elective Caesarean section today. How do you assess, optimize, and anaesthetize this patient?
• SCENARIO 2: A 22-year-old primigravida at 34 weeks gestation with Sickle Cell Disease (HbSS, baseline steady-state Hb 6.5 g/dL) is admitted with acute chest syndrome, pleuritic chest pain, fever 38.6°C, cough, and SpO₂ 89% on room air. Simultaneously, she enters active preterm labour with foetal distress. How do you formulate your perioperative anaesthetic and intensive care management strategy?
• SCENARIO 3: A 30-year-old G3P2 at 32 weeks gestation with a St. Jude mechanical mitral valve prosthesis on therapeutic low-molecular-weight heparin (LMWH) presents in established labour (cervix 6 cm dilated) with bleeding per vaginam. Her last dose of therapeutic enoxaparin was administered 6 hours ago. The obstetrician decides on an urgent Caesarean section for non-reassuring foetal status. Detail your haematological risk assessment, choice of anaesthetic technique, and perioperative management.
• SCENARIO 4: A 28-year-old G1P0 at 38 weeks gestation with a history of generalized Myasthenia Gravis (Osserman Class IIb) on oral pyridostigmine and prednisolone is admitted for elective Caesarean section. Outline your pre-operative evaluation, anaesthetic management, choice of drugs, and post-operative monitoring plan for both mother and neonate.