Rare Airway Obstruction Successfully Treated in Pregnant Patient,Highlighting Critical Need for Specialized Care
BOSTON,MA – In a remarkable case demonstrating the power of multidisciplinary collaboration,physicians at Massachusetts General Hospital (MGH) successfully treated a pregnant patient experiencing severe subglottic stenosis,a rare narrowing of the airway below the vocal cords.The case, detailed in a recent publication, underscores the unique challenges and critical need for specialized airway management in pregnant women.
The patient, a 32-year-old with a history of intubation for a previous unrelated medical condition, presented at 30 weeks gestation with progressively worsening shortness of breath. Diagnostic imaging revealed meaningful subglottic stenosis, severely compromising her airway. Pregnancy-related physiological changes, including increased oxygen demand and airway edema, further complicated the situation, posing a life-threatening risk to both mother and fetus.Subglottic stenosis affects an estimated 1 in 6,000 to 1 in 18,000 individuals, and its incidence may be underestimated due to diagnostic challenges.The condition often arises following prolonged intubation, trauma, or infection. Successful management during pregnancy is particularly complex due to limited therapeutic options and the potential for fetal harm.
A team comprised of anesthesiologists specializing in obstetric airway management,otolaryngologists,and maternal-fetal medicine specialists devised a meticulously planned approach. Recognizing the risks associated with general anesthesia,the team opted for a minimally invasive procedure performed while the patient was awake,utilizing flexible bronchoscopy and balloon dilation to carefully widen the narrowed airway.
“The primary concern was ensuring adequate oxygenation for both the mother and the baby,” explained dr. Neel Shah, lead anesthesiologist on the case. “Customary surgical interventions carry significant risks during pregnancy, so we prioritized a less invasive technique that would allow us to address the stenosis without compromising fetal well-being.”
The procedure was successful, substantially improving the patient’s airway and alleviating her respiratory distress. She was closely monitored throughout the remainder of her pregnancy and delivered a healthy baby at term via scheduled Cesarean section.The case highlights the importance of early diagnosis and prompt intervention in pregnant patients with airway obstruction. Experts emphasize that any pregnant woman experiencing unexplained shortness of breath should undergo thorough evaluation to rule out airway pathology. Further research is needed to develop standardized protocols for airway management in this vulnerable population.
