Conservative management of subglottic stenosis in pregnancy resulting in vaginal birth

Subglottic tracheal stenosis complicating pregnancy: A case report

The case presented details an uncommon case of subglottic tracheal stenosis exacerbated by pregnancy. We outine the multidisciplinary management involved and the outcomes for the pregnancy. The case serves as a reminder that shortness of breath in pregnancy has a broad differential diagnosis, and stridor is always abnormal.

Endoscopic management of idiopathic subglottic stenosis in pregnancy

Aims

To describe the use of laser, endoscopic balloon dilatation with jet ventilation anaesthesia in the treatment of pregnant women with idiopathic subglottic stenosis.

Materials and methods

This is a case review of pregnant women with idiopathic subglottic stenosis, presenting to a tertiary referral centre with worsening breathlessness. Data were extracted from patient case notes.

Results

Four women underwent surgical management of subglottic stenosis in pregnancy. One patient required two procedures during the course of their pregnancy due to restenosis. All women had improvement in symptoms post-operatively and went on to deliver healthy babies at term.

Conclusion

Endoscopic balloon dilatation of idiopathic subglottic stenosis is a safe and viable treatment option in pregnancy and should be offered as first-line treatment in symptomatic women.

Pregnancy-associated idiopathic laryngotracheal stenosis: presentation, management and results of surgical treatment

OBJECTIVES

Idiopathic laryngotracheal stenosis (ILTS) is an uncommon problem arising mostly in women. In some, it arises during or is exacerbated by pregnancy. Experience with management of patients with this rare association is limited. This study seeks to evaluate the management of patients with pregnancy-associated ILTS and compare outcomes to cases not associated with pregnancy.

METHODS

Retrospective review of 15 patients undergoing surgical treatment of pregnancy-associated ILTS from 1971 to 2013. Variables of interest and airway outcomes were compared to patients with non-pregnancy-associated ILTS.

RESULTS

Pregnancy-associated ILTS was observed in 15/263 (5.7%) patients. Symptoms developed during their first pregnancy. When compared to non-pregnancy patients, these patients were younger (37 vs 47 years; P = 0.0003), had more prior tracheostomies (26.7% vs 10.9%; P = 0.085) and had more preoperative airway dilatations (86.7% vs 57.7%; P = 0.030). All patients completed pregnancy without complications and ultimately underwent laryngotracheal resection. The expression of hormonal receptors in the surgical specimens was similar in both groups (oestrogen receptors: 100% vs 75% and progesterone receptors: 71.4% vs 72.1%, in pregnancy and non-pregnancy patients, respectively). Airway outcomes were good/excellent in 13 (86.7%) patients with pregnancy-associated ILTS and 225 (90.7%) patients without pregnancy association (P = 0.642), and did not change when adjusting for other risk factors.

CONCLUSIONS

Pregnancy-associated ILTS is rare. The pathophysiology is unclear, but appearance of symptoms during pregnancy may suggest hormonal factors. To minimize foetal risk, dilatation during pregnancy followed by laryngotracheal resection after delivery is the preferred treatment. Pregnancy association does not seem to affect outcomes with expected satisfactory results in most patients.

Successful management of subglottic stenosis in pregnancy

Evaluation and management of subglottic stenosis in pregnancy is challenging. It often is not only a multidisciplinary approach between obstetricians, otolaryngologists (ENT surgeons) and anesthesiologists, but also requires a thorough understanding of possible foreseen complications by the patient as well. Hence, whenever we are presented with a challenging case requiring multidisciplinary approach involving team of physicians from different specialties, it is routine practice to huddle regarding the preoperative, intraoperative and postoperative management and care. We present a case of a 37-year-old woman with a known history of idiopathic subglottic stenosis, 16 weeks' pregnant, G4P1, with a surgical history significant for two previous subglottic dilations in the past and who now presented with an audible stridor and shortness of breath on activity. We highlighted the unique challenges encountered and the corresponding management adopted. This is a case of successful management of symptomatic worsening of subglottic stenosis managed during pregnancy.

Management of subglottic stenosis in pregnancy using advanced apnoeic ventilatory techniques

Objective

To describe the use of balloon dilation with non-invasive ventilation in the treatment of pregnant patients with idiopathic subglottic stenosis.

Methods

The medical charts of four consecutive patients who underwent jet ventilation or high-flow nasal cannula oxygenation with balloon dilation for the treatment of idiopathic subglottic stenosis during pregnancy were reviewed.

Results

Objective improvement of subglottic stenosis was seen in all four cases, with end-result Myer–Cotton grade 1 lesions down from pre-procedure grade 3 lesions. Patients also reported subjective improvements in symptomatology, with no further airway issues. All patients delivered normally, at term.

Conclusion

Laryngeal dilation with continuous radial expansion pulmonary balloons using non-invasive ventilation for the treatment of idiopathic subglottic stenosis in pregnant patients is safe and efficacious, and should be the first line treatment option for this patient population. The improvement in symptoms, and lack of labour and pregnancy complications, distinguish this method of treatment from others reported in the literature.