Surgical Management of Airway Stenosis During Pregnancy: A Scoping Review

• Published in: The Laryngoscope 2024-03, Vol.134 (3), p.1014-1022
• Main Authors: Miller, Katherine M., Liang, Kevin Y., Nero, Neil, Benninger, Michael S., Nelson, Rebecca C., Tierney, William S., Lorenz, Robert R., Bryson, Paul C.
• Format: Article
• Language: English
• Subjects: Childbirth & labor; endoscopic balloon dilation; Endoscopy; Female; Humans; Laryngostenosis - surgery; Ostomy; Pregnancy; Pregnancy Complications - surgery; subglottic stenosis; surgical management; Tracheal Stenosis - surgery
• ISSN: 0023-852X; 1531-4995; 1531-4995
• DOI: 10.1002/lary.30994

Objective There are several options for surgical management of subglottic stenosis, including endoscopic and open procedures. However, treatment algorithms, outcomes, and anesthetic management of subglottic stenosis during pregnancy are not well described. Data Sources MEDLINE, EMBASE, and the Cochrane databases. Review Methods A scoping review of management of subglottic stenosis during pregnancy was performed, and then reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Inclusion criteria consisted of those with subglottic or tracheal stenosis aged greater than 18 years, those in whom management was performed during pregnancy, and those who reported delivery related outcomes. Results After systematic review and detailed search of 330 identified articles, 15 articles met inclusion criteria and were included in the final analysis. All studies were case reports or case series (level 4 evidence). This study identified 27 patients. The median age was 29 and the median gestational age at intervention was 28 weeks. Left lateral positioning and fetal heart rate monitoring were used in nearly every case. The most common intervention performed was endoscopic balloon dilation. In many cases, jet ventilation or transnasal humidified rapid insufflation ventilatory exchange was satisfactory for maintenance of the airway. Three women ultimately required tracheostomy prior to labor and delivery. There was no fetal death or complications reported in these studies, and all but one woman proceeded to deliver at term. Conclusion Endoscopic balloon dilation during pregnancy is safe and effective, resulting in optimized respiratory outcomes for the mother and safe delivery of the fetus. The third trimester appears to be safe for airway intervention. Laryngoscope, 134:1014–1022, 2024 This scoping review examines the available literature surrounding the management of subglottic and airway stenosis in pregnancy. It demonstrates that airway dilatations have been performed safely in the second and third trimesters. It also shows that airway managements typically results in a healthy and term delivery.