The perinatal management of severe laryngeal stenosis.
BACKGROUND: Conditions that completely occlude the fetal larynx are rare. We describe the perinatal course of an infant with severe congenital subglottic stenosis, for whom the prenatal recognition of airway occlusion led to enhanced neonatal management. CASE: Serial ultrasound examinations from 23-37 weeks' gestation led to the diagnosis of upper airway obstruction in the fetus of a 29-year-old woman. Significant findings included fetal ascites, echogenic enlarged lungs, and a dilated fluid-filled trachea. The infant was delivered in a level III hospital with a neonatologist and anesthesiologist in attendance. The cord was not clamped until a tracheostomy was secured. CONCLUSION: Upper-airway obstruction can be diagnosed prenatally by the presence of secondary manifestations. Infant survival may depend on foreknowledge of the pathology and prompt, directed efforts at bypassing the airway obstruction.