O&G Cases · Antenatal care — maternal medical conditions
Class III obesity at caesarean — peri-operative management station
Team-based peri-caesarean station for a class III obese woman with OSA. Tests the anaesthetic-airway plan, surgical access and equipment, weight-adjusted antibiotic dosing, weight-based enoxaparin with the Overcash and Stephenson evidence, wound-closure strategy, postoperative monitoring, and closed-loop communication. Includes assessor key and marking domains.
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Target exams
Station brief
Format. Peri-operative management station, approximately 12 minutes. You are the obstetric registrar in theatre with a scrub midwife and a senior anaesthetist; the consultant is 15 minutes away and has been called. The assessor runs the clock and feeds you intra-operative observations. [1]
Candidate instruction. Lead the peri-operative bundle for caesarean in class III obesity: confirm the anaesthetic-airway plan, the equipment and antibiotic dosing, lead intra-operatively, and prescribe the postoperative thromboprophylaxis and monitoring. Verbalise your orders with doses and your escalation triggers, and communicate with the team and the woman. [1][2]
References4ShowHide
- [1]Denison FC, Aedla NR, Keag O, Hor K, Reynolds RM, Milne A, Diamond A; Royal College of Obstetricians and Gynaecologists Care of Women with Obesity in Pregnancy: Green-top Guideline No. 72 BJOG, 2019.PMID 30465332
- [2]American College of Obstetricians and Gynecologists ACOG Practice Bulletin No. 156: Obesity in Pregnancy Obstet Gynecol, 2015.PMID 26595582
- [5]Overcash RT, Somers AT, LaCoursiere DY Enoxaparin dosing after cesarean delivery in morbidly obese women Obstet Gynecol, 2015.PMID 26000508
- [6]Stephenson ML, Serra AE, Neeper JM, Caballero DC, McNulty J A randomized controlled trial of differing doses of postcesarean enoxaparin thromboprophylaxis in obese women J Perinatol, 2016.PMID 26658126