Labour: contraindications to neuraxial block: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Labour: contraindications to neuraxial block

Sample item

A woman in labour has a platelet count of 40,000 per microlitre with a prolonged prothrombin time and a request for epidural analgesia. Why is the epidural contraindicated?

AIt prevents the use of oxytocinBCoagulopathy raises the risk of a spinal epidural haematomaCIt would cause fetal acidosis directlyDIt would reduce uterine contractions in all cases

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Coagulopathy raises the risk of a spinal epidural haematoma

Neuraxial techniques are contraindicated by clinically significant coagulopathy, sepsis at the site, hypovolaemia and refusal. The danger of an epidural haematoma compressing the cord is greatest with thrombocytopenia below about 70,000, a prolonged INR or recent therapeutic anticoagulation. Alternative analgesia such as remifentanil patient-controlled analgesia can be offered.

Option by option

A. It prevents the use of oxytocin
Oxytocin is compatible with epidural analgesia.
B. Coagulopathy raises the risk of a spinal epidural haematoma (correct)
Correct. Coagulopathy risks a compressive epidural haematoma.
C. It would cause fetal acidosis directly
The risk is maternal bleeding, not direct fetal acidosis.
D. It would reduce uterine contractions in all cases
An epidural does not generally stop contractions and that is not the reason.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Coagulopathy raises the risk of a spinal epidural haematoma. Neuraxial techniques are contraindicated by clinically significant coagulopathy, sepsis at the site, hypovolaemia and refusal.

Why is "It prevents the use of oxytocin" not the answer?

Oxytocin is compatible with epidural analgesia.

Why is "It would cause fetal acidosis directly" not the answer?

The risk is maternal bleeding, not direct fetal acidosis.

Why is "It would reduce uterine contractions in all cases" not the answer?

An epidural does not generally stop contractions and that is not the reason.

What concept does this question test?

It tests Labour: contraindications to neuraxial block in OBG. The danger of an epidural haematoma compressing the cord is greatest with thrombocytopenia below about 70,000, a prolonged INR or recent therapeutic anticoagulation. Alternative analgesia such as remifentanil patient-controlled analgesia can be offered.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Labour: contraindications to neuraxial block?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.