Surgical Management of Idiopathic Subglottic Stenosis During Pregnancy: A Multi-Institutional Study.

Abstract

Managing idiopathic subglottic stenosis (iSGS) during pregnancy presents distinct clinical challenges. As pregnancy is a naturally dyspneic state, the development of iSGS may exacerbate respiratory symptoms and compromise the airway-potentially impacting pregnancy and delivery decisions. This study characterizes surgical management strategies and outcomes in pregnant patients with symptomatic iSGS. We conducted the largest known multi-institutional retrospective review of pregnant patients who underwent endoscopic intervention for iSGS. Demographics, procedural details, anesthesia and medication use, and maternal and neonatal outcomes were analyzed. Twelve patients underwent 15 endoscopic procedures during pregnancy: 9 laser wedge excisions (8 CO₂ laser and 1 coblator) and 6 balloon dilations. Three additional procedures in different patients occurred postpartum (2-11 months after delivery). Higher-risk pregnancies included two twin gestations, one patient with multiple surgeries during two different pregnancies, and two patients over age 35. Most interventions (87%) occurred in the second trimester. Fetal monitoring was performed preoperatively and postoperatively. Fentanyl and propofol were used in 88% and 94% of cases, respectively; rocuronium was the most common neuromuscular blocker (70%). One patient underwent balloon dilation via flexible bronchoscopy without anesthesia. Jet ventilation was used in 53% of cases, and Size C Kleinsasser laryngoscopes in 47%. Median procedure times were 75, 19, and 18 min for laser wedge excision, balloon dilation, and coblation, respectively. Most patients delivered full-term with no surgical or postpartum complications. Endoscopic intervention for iSGS during pregnancy appears safe and effective, even in high-risk cases. These findings support individualized airway management and inform future practice.