Interdisciplinary Management of a functionally relevant subglottical stenosis during pregnancy

Introduction The idiopathic progressive subglottic stenosis (IPSS) almost exclusively concerns women at the age of 20 to 60 years. Etiology is unclear, but after estrogen receptors were detected in the subglottic tissue, a hormone triggered genesis can be assumed.

Case report We present the case of a 35-year-old pregnant woman who came to our ENT clinic in her 16th pregnancy week because of a functionally relevant subglottical stenosis. The endoscopy showed a circumferent stenosis in the cricoid area having a just 5-millimeter-wide lumen. We performed an elective tracheotomy in her 33rd pregnancy week in strictly interdisciplinary management. Afterwards she was not able to exert abdominal pressure and therefore a vaginal birth got impossivble. So the delivery was done complication-free as caesarean section. After the patient finished breastfeeding her baby, we planned a cricotracheal resection and closing of her tracheostoma. The surgery went well without any complications and the patient got free of complaints.

Conclusion A functionally relevant subglottical stenosis during pregnancy requires close interdisciplinary teamwork to reach the best outcome for mother and child. Especially the question of a vaginal delivery needs to be discussed critically. In our case the patient had a severe stenosis, so we decided, in respect of safeness, to perform a tracheostomy first and afterwards a caesarian section.

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Publication History

Article published online:
10 June 2020