Postoperative Complications, Gynaecological Sepsis, and Critical Care in Gynaecology — WACS Viva & Clinical Scenarios (Gynaecology)

Exam-style postoperative complications, gynaecological sepsis, and critical care in gynaecology viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 36-year-old woman is in the recovery room 3 hours following an uncomplicated total abdominal hysterectomy. She becomes restless, pale, and cold. Her BP is 75/40 mmHg, HR 140 bpm, and abdominal drain has yielded 800 mL of frank blood over the last hour. The surgical team decides to re-explore immediately. Detail your resuscitation, re-induction, and intraoperative anaesthetic plan.
• SCENARIO 2: A 22-year-old woman is admitted to the ICU 48 hours following an unsafe criminal abortion. She is intubated, in septic shock on high-dose noradrenaline (0.4 mcg/kg/min), febrile (39.8°C), jaundiced, oliguric (creatinine 380 µmol/L), with PaO2/FiO2 ratio of 140. Discuss your multi-organ critical care management for this patient over the next 24 hours.
• SCENARIO 3: On the third postoperative day following an extensive staging laparotomy for ovarian cancer, a 55-year-old woman suddenly collapses while mobilising, with severe dyspnoea, pleuritic chest pain, cyanosis, BP 60/40 mmHg, and HR 135 bpm. Bedside echocardiography shows acute right ventricular dilation and D-shaped left ventricle. Outline your immediate resuscitative and anaesthetic management for suspected massive pulmonary embolism.
• SCENARIO 4: A 48-year-old diabetic woman presents with fulminant necrotising fasciitis of the vulva, perineum, and lower abdominal wall (female Fournier's gangrene) following an infected Bartholin's gland abscess. She is in severe septic shock and ketoacidosis. Describe your perioperative resuscitation, anaesthetic management for radical debridement, and postoperative critical care strategy.