Labour: anaesthesia for caesarean: 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: anaesthesia for caesarean

Sample item

A woman receiving spinal anaesthesia for a caesarean section becomes nauseous with a fall in blood pressure from 120/70 to 78/40 mmHg. Besides left uterine displacement and fluid co-loading, which drug is preferred first-line?

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

The answer and the reasoning

A. Phenylephrine bolus

Spinal-induced hypotension results from sympathetic blockade and is treated with a vasopressor, and phenylephrine is the first choice because it improves umbilical artery pH better than ephedrine. Ephedrine crosses the placenta and can cause fetal acidosis and tachycardia. Left uterine displacement reduces aortocaval compression.

Option by option

  • A. Phenylephrine bolus (correct)

    Correct. Phenylephrine is the preferred vasopressor for spinal hypotension in caesarean section.

  • B. Atropine

    Atropine treats bradycardia but is not the first drug for vasodilatory hypotension.

  • C. Intravenous labetalol

    Labetalol would lower pressure further.

  • D. Ephedrine in a high dose repeatedly

    Ephedrine is acceptable but is associated with fetal acidosis and is not the preferred agent.

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.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Phenylephrine bolus. Spinal-induced hypotension results from sympathetic blockade and is treated with a vasopressor, and phenylephrine is the first choice because it improves umbilical artery pH better than ephedrine.

Why is "Atropine" not the answer?

Atropine treats bradycardia but is not the first drug for vasodilatory hypotension.

Why is "Intravenous labetalol" not the answer?

Labetalol would lower pressure further.

Why is "Ephedrine in a high dose repeatedly" not the answer?

Ephedrine is acceptable but is associated with fetal acidosis and is not the preferred agent.

What concept does this question test?

It tests Labour: anaesthesia for caesarean in OBG. Ephedrine crosses the placenta and can cause fetal acidosis and tachycardia. Left uterine displacement reduces aortocaval compression.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: anaesthesia for caesarean?

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.