STAT Cesarean — Severe Preeclampsia

About this case

A 32-year-old at 36 weeks with severe preeclampsia and HELLP needs an immediate caesarean for fetal bradycardia. Her epidural is patchy, her platelet count is 78k, and her airway is oedematous — three problems that constrain each other, which is precisely why the case is set up this way.

Key clinical features

• Severe Preeclampsia

  BP 178/115 · headache · scotomas · clonus 4+

• HELLP Syndrome

  Plt 78k, AST 412, hemolysis on smear

• Failed Epidural

  Patchy sensory block, fetal bradycardia — needs GA NOW

• Difficult Airway

  Edematous oropharynx, full term, Mallampati IV

What the examiner is testing

• How you resolve competing pressures: the regional technique is compromised, the airway is predicted difficult, and the fetus will not wait.
• Whether your airway preparation reflects the specific risks of a term parturient rather than a generic difficult-airway plan.
• Your handling of the thrombocytopenia in the neuraxial decision, and how you communicate that reasoning.
• Blood pressure and seizure-prophylaxis management alongside the delivery, not sequenced after it.

Where candidates lose points

• Committing to general anaesthesia without a stated plan for the anticipated difficult airway.
• Managing the obstetric emergency while losing track of the maternal preeclampsia problem.
• Failing to plan the postoperative course, where HELLP continues to evolve.

How it is scored

Every BoardSim case is scored across the same five phases — pre-operative evaluation, anaesthetic plan, intra-operative management, crisis management, and emergence — for a total of 100 points, with a pass set at 70 and no missed critical action. You receive a written report against each phase rather than a single number. Read the scoring methodology.