Obstetric Critical Care and Postpartum Emergencies in ICU — WACS Viva & Clinical Scenarios (ICU & HDU)

Exam-style obstetric critical care and postpartum emergencies in icu viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 26-year-old primigravida at 36 weeks gestation is transferred to the ICU from the labour ward following two generalized tonic-clonic seizures. She is unextubated, blood pressure is 210/120 mmHg, heart rate is 124 beats/min, SpO₂ is 88% on 10 L/min oxygen mask, and diffuse bilateral crepitations are heard throughout both lung fields. Laboratory results reveal platelets 38,000/mm³, AST 450 IU/L, ALT 380 IU/L, and creatinine 210 µmol/L. Outline your immediate emergency critical care interventions to stabilize maternal blood pressure, manage acute pulmonary oedema, control seizures, and optimize
• SCENARIO 2: A 32-year-old Para 4+0 is admitted to the ICU immediately following an emergency peripartum hysterectomy for catastrophic atonic postpartum haemorrhage. Estimated intraoperative blood loss was 4.5 litres. She is receiving noradrenaline at 0.3 mcg/kg/min; her blood pressure is 84/46 mmHg, heart rate 136 beats/min, temperature 34.8°C, and active ooze is noted from the surgical abdominal drain, peripheral puncture sites, and urinary catheter. Arterial blood gas shows pH 7.14, base excess -14 mmol/L, lactate 6.5 mmol/L, and ionized calcium 0.82 mmol/L. Detail your resuscitative strategy addressing
• SCENARIO 3: A 29-year-old multigravida suddenly collapses during the second stage of labour with profound dyspnoea, cyanosis, seizure-like activity, and subsequent unresponsiveness. Immediate CPR is commenced, she is intubated, and emergency perimortem caesarean section is performed within 4 minutes, delivering a live neonate. Spontaneous circulation returns, but she remains in profound shock (BP 68/35 mmHg on high-dose adrenaline) with severe pulmonary oedema (SpO₂ 82% on FiO₂ 1.0, PEEP 12 cmH₂O) and massive vaginal bleeding without clot formation. Describe your ICU management of suspected amniotic fluid
• SCENARIO 4: A 30-year-old woman, 10 days postpartum following a normal vaginal delivery, presents with progressive orthopnoea, paroxysmal nocturnal dyspnoea, and severe peripheral oedema. In the ICU, she is in severe respiratory distress, respiratory rate 38 breaths/min, heart rate 130 beats/min (sinus tachycardia), blood pressure 92/60 mmHg, and bilateral basilar crackles up to mid-zones. Bedside echocardiography demonstrates a dilated left ventricle with an ejection fraction of 20% and moderate functional mitral regurgitation. What is your comprehensive ICU management protocol for acute peripartum cardi