Peri-partum management of subglottic stenosis in pregnancy in the morbidly obese patient with mental health problems: planning ahead H Abdullah, K Sainsbury, A Popon Department of Anaesthesia University Hospitals Birmingham NHS Foundation Trust Case Report ➢27-year-old, known subglottic stenosis requiring repeat balloon dilatation every 6 months ➢Morbid Obesity BMI 50.5, reflux, ➢Anxiety, PTSD, Borderline personality disorder ➢Referred to anaesthetic assessment clinic at 13 weeks of pregnancy with worsening symptoms at 16 weeks followed by tracheal dilatation ➢Tracheal dilatation at 32 weeks of pregnancy ➢Required obstetrics, anaesthetics, midwifery, thoracic surgery, perinatal mental health team delivering care across 3 sites ➢Deemed safe for delivery at DGH by thoracic surgery after dilatation at 32 weeks ➢Patient wished for vaginal delivery despite obstetrician recommending elective LSCS ➢Anaesthetic plan for early epidural and prompt availability of senior help with anticipated difficult airway and ventilation at DGH ➢Short labour for primigravida delivered with episiotomy, time not allowing for epidural Discussion ✓Rare disease presentation ✓Idiopathic ✓More frequent requirement for balloon dilatation in pregnancy ✓Involvement of multiple teams ✓Care delivery across multiple sites ✓Continuity of care ✓Decision-making about the location of delivery ✓Reviewing the trend of efficacy of tracheal dilatation ✓Balancing safety with patient wishes and patient counselling ✓Supporting the patient’s mental health ✓Peri-partum anaesthetic plan – prioritising early regional analgesia/ anaesthesia ✓Preparation for sub-glottic difficult airway compounded by obesity – known easy glottic visualisation ✓Plan for recruiting additional support if assistance is required in an emergency Introduction Subglottic tracheal stenosis introduces additional challenges to patient care for the multi-disciplinary team. It is a rare disorder with risk of life-threatening airway compromise(1). Severe cases often require surgical intervention in the peripartum period(2). We present a case of peripartum management of a patient with idiopathic tracheal stenosis References 1.A. Scholz, K. Srinivas, M. R. W. Stacey, P. Clyburn. Subglottic stenosis in pregnancy. British Journal of Anaesthesia.2008; 100: 385-8. 2.Miller, K.M., Liang, K.Y., Nero, N., et al. Surgical Management of Airway Stenosis During Pregnancy: A Scoping Review. The Laryngoscope. 2024 https://doi.org/10.1002/lary.30994 Follow up ❖Post-natal follow-up 2 weeks after delivery ❖Remained well. No respiratory or mental health concern