Pregnancy and stenosis

It is a good idea to make sure your specialists for SGS and pregnancy are in contact with one another. It is an added advantage if they are in the same hospital, but this is not always possible. If they are at different hospitals, we recommend you make yourself aware of who will be able to help you in an emergency at both hospitals for both your stenosis and pregnancy, even if they are not currently treating you.

 

Unfortunately, your SGS specialist may not have experience treating someone with SGS during a pregnancy. To date, there are only 6-7 reported cases of management of SGS in pregnancy in literature. Gynaecologists and Obstetricians may also never have come across anyone with SGS, so you may need to bear this in mind when you are looking at getting advice and treatment options.

 

Even if you do not have any issues apart from your stenosis during pregnancy, it is advisable to arrange to deliver your baby in hospital. In case you need any kind of surgery for delivery of the baby, you are still an intubation risk and will need specialist anaesthetic care in surgery.

 

Airway Surgery During Pregnancy

If you need treatment on your airway during pregnancy; Don't panic! Many patients have needed steroid injections or dilation surgery throughout their pregnancy, and these have usually gone smoothly with very few risks to the unborn child.

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We recommend you consider a few things to ensure the pregnancy and birth goes as smoothly as possible:

• Talk to your airway surgeon about in-office steroid injections. These do not involve sedation and have proven to be a safe and harm free way to treat patients while they are pregnant.

• If in office steroid injections are not available, speak to your airway surgeon and gynaecologist/obstetrician about the optimal time to have surgery during your pregnancy. This usually somewhere between 20 and 24 weeks, but it really depends on your individual situation. Bear in mind that this may also be dictated by other factors, especially your airway and how short of breath you are.

• Make sure your specialists are in contact with each other and that your surgeon is aware of any additional information regarding your pregnancy which could impact the operation. Similarly, make sure that any medication they intend to give you during your airway surgery has been checked by your obstetrician to ensure it is as safe as possible.

• Speak to the anaesthetist department before the surgery to double check everything with them. Make sure they are aware of both your stenosis and your pregnancy and have been in contact with your specialists.

• Try to ensure an obstetrician checks the baby before and after the surgery. If you are above a certain number of weeks into your pregnancy it may be necessarily have someone present during surgery to monitor the baby.

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Frequently Asked Questions

What is the safest treatment for me while I am pregnant?

Airway stenosis in pregnant SGS patients can be treated in the office with awake, unsedated injections of steroid medication. This technique was reported in 2 papers in the medical literature, in 2017, and included one pregnant patient. Anecdotal evidence from some of the top airway surgeons suggests several patients have got through their pregnancy with injections alone. It may be the safest and most cost-effective way to treat the condition during pregnancy. You may ask your airway surgeon about this option and whether it is available for you.

 

Patients commonly receive submucosal administration of triamcinolone, dexamethasone, methylprednisolone, or solumedrol directly in the stenosis (there are no established differences between reagents). This is frequently repeated 3-5 times (at 3-week intervals) at which time patients are transitioned into clinical surveillance. Both systemic (i.e. intravenous or oral) and inhaled steroids (both nasal and pulmonary) have an established track record in pregnancy (particularly is asthmatic patients) and are widely regarded as safe in pregnancy.

 

Do I really need surgery during pregnancy?

This is not always a simple question and is largely based on how well you are breathing and the advice of your ENT/obstetrician. Struggling through if you are really closing and your breathing is not good could put your baby at risk. Something to bear in mind is that it is generally a lot safer to have a carefully planned dilation than to get into any kind of emergency regarding breathing and/or surgery, particularly if in-office steroid injections are not available to you.

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Will the anaesthetic and drugs harm my baby?

While there is obviously a risk, nowadays they have made things as safe as possible for surgery during pregnancy. Check with your doctors if you are unsure of anything. Remember that you need this surgery for a reason, and not getting enough air in could be just as harmful to the baby, if not more so. All anaesthetic drugs can theoretically cross the placenta. Yet despite years of animal studies and observational studies in humans, no aesthetic drug has been shown to be clearly dangerous to the human foetus. There is no single optimal anaesthetic technique.

 

If in office steroid injections are not available to me, can I have steroid injections after my dilation while pregnant?

It is generally felt that directly injecting them into the stenosis is the safest form of administration during pregnancy. Steroid injections may negate the need for further surgery during pregnancy.

 

My surgeon wants to give me a tracheotomy to get me through my pregnancy. Is this necessary?

While this may be necessary in some cases, the majority of with SGS during pregnancy do not require a tracheotomy during pregnancy. If your surgeon or obstetrician is wanting to place one simply because you are pregnant you may wish to seek a second opinion. The health of you and your baby is of utmost importance. If it does become necessary, it may only be temporary and there will likely be good reasons why you need it.

 

My obstetrician wants to plan a C-section because I have SGS - do I need a C-section, or can I deliver the baby naturally?

Many SGS patients have delivered babies naturally, so stenosis alone should not necessarily be a reason why you cannot have a natural birth if you choose to. That being said, there may be other additional reasons why a C-section is recommended, and it is important to follow the advice of your doctors on this.

 

Will I need to be intubated to deliver my baby?

The good news is that most planned surgery for delivery is usually done using other methods such as an epidural, which won't require intubation. However, it is a good idea to get a note from your ENT about what is needed in terms of anaesthesia, specifically, what size endotracheal tube is needed if you must be intubated in the event you need any emergency surgery.

 

Tips for dealing with SGS during pregnancy

If you are taking any medication for your stenosis make sure that you check with your doctor if it is safe to use during pregnancy. If you have a lot of mucus, nebulising with cool boiled water or saline might help as an alternative to expectorant medication. See our section on reducing mucus naturally.

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Make sure you carry a note with brief details of your stenosis and pregnancy, and what to do with your airway in the event of an emergency. Usually, this contains suggestion regarding avoiding intubation, use of a small size breathing tube (4.5-5.5 usually) if intubation is necessary. Remember to include details of your doctors and how to contact them.

 

If you think you feel out of breath, don't wait to see your doctor. Some patients close quite quickly during pregnancy and you may want to get it checked out.

 

A few weeks before your due date, have a check-up with your airway doctor so you have an idea of how your airway is looking and how open or closed you are before you deliver. Use of a peak flow meter during your pregnancy may be helpful to track the size of your airway.

 

Try to relax! While it can be stressful and scary dealing with this condition during pregnancy - try not to get worried about it.