Subglottic stenosis in pregnancy

Abstract

Subglottic stenosis (SGS) in pregnancy is rare but may cause a potentially life-threatening delivery and is a challenge to the anaesthetist and the obstetrician. Clinical signs of SGS may not be obvious and the diagnosis can be difficult. Patients usually present with shortness of breath rather than stridor. Many patients have been wrongly diagnosed with asthma and recurrent bronchitis before subsequent discovery of a SGS. Early diagnosis of SGS and multidisciplinary input is important in managing these patients. We present a case of a pregnant woman with a history of Wegener's granulomatosis and the successful multidisciplinary management of her SGS.

Idiopathic subglottic stenosis in pregnancy: A deceptive laryngoscopic view

“…Conditions that promote airway oedema may result in asymptomatic SGS to manifest with breathlessness. [1] In this case, pregnancy and pre-eclampsia might have contributed to airway oedema, although she remained sub-symptomatic till the last stage of pregnancy. Unfortunately, ability to mask ventilate could not be checked prior to laryngoscopy; thus, it is difficult to ascertain if intubation attempts contributed to worsening of the situation.…”

“…[1] However, idiopathic SGS commonly occurs in women, which is believed to be related to hormonal factors. [2] Its occurrence during pregnancy is rare and very few cases have been reported in the literature.…”

“…[2] Its occurrence during pregnancy is rare and very few cases have been reported in the literature. [125–7] SGS of pregnancy is probably a misnomer. Conditions that promote airway oedema may result in asymptomatic SGS to manifest with breathlessness.…”

“…Often, this may be the only telltale sign of SGS which can easily be misdiagnosed and treated as bronchial asthma with poor response to bronchodilators. [1–3] When such patients with undiagnosed SGS undergo general anaesthesia (GA), a catastrophic series of events may occur following induction. Multiple attempts at intubation by an unsuspecting team of anaesthesiologists, enamoured by an easy laryngoscopic view, can result in a life-threatening “ cannot ventilate, cannot intubate ” scenario, while forceful attempts may even lead to the damage of the laryngeal cartilages or perforation of the trachea.…”

Subglottic stenosis and acute airway obstruction

“…The majority of cases are diagnosed within a year. Symptoms[1] include dyspnea (may be on exertion or with rest, depending on the severity of stenosis),stridor, hoarseness, brassy cough, recurrent pneumonitis, cyanosis. Management in all these situations needs to be prompt and definitive.…”