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• W2039916595 abstract "A 30 year old woman at 40 weeks of gestation with three previous normal deliveries was admitted to the delivery suite with a sudden onset of difficulty in breathing for about two hours. She also complained of pain around her neck and upper chest, and had dysphonia with marked hoarseness. She had a history of some malaise and a mild sore throat for the previous 48 hours. There was no history of asthma, drug intake, allergy, calf pain or swelling, and she was a non-smoker. Her antenatal course until that time had been uneventful. On examination she was very distressed and severely dyspnoeic. Her temperature was 38 C, pulse rate 100 beats per minute, systolic/diastolic blood pressure 100/60mmHg and respiratory rate 25/minute. Her face looked flushed and an inspiratory stridor was noted. Examination of her chest was normal. She was given 40% oxygen by mask and her oxygen saturation was 98%. A cardiotocograph showed a normal fetal heart rate. An ear, nose and throat specialist was consulted. In view of the urgency of the situation she immediately underwent direct flexible laryngoscopy in the outpatient clinic of the ear, nose and throat department. The laryngoscopy showed a normal glottis and supraglottis but marked inflammation of the tracheal mucosa with a lot of exudates and crusting. A diagnosis of acute severe tracheitis with upper airway obstruction was made. In view of the crusting, it was felt that there was a risk of complete obstruction of the trachea. After consultation between obstetricians, anaesthetists and ear, nose and throat surgeons, a tracheostomy under local anaesthesia was performed. Once the tracheostomy tube was safely inserted general anaesthesia was induced and a lower segment caesarean section performed. There was no time to perform a lateral X-ray of the neck before performing the tracheostomy. A male infant was born in good condition and weighed 4.19kg. The interval between induction of anaesthesia and delivery was 10 minutes. Umbilical cord arterial blood analysis showed a pH of 7.32, pCO2 2.15kPa, pO2 7.48kPa and base excess of 15.9mmol/L. The high base deficit and low pCO2 indicates that the infant had a metabolic acidosis, probably resulting from the maternal acidosis. The woman was prescribed co-amoxyclav 1.2g intravenously eight-hourly and transferred to the ear, nose and throat ward for close observation. Humidified oxygen was administered by a face mask. A post-operative chest X-ray was normal. Tracheal swabs did not show any significant bacterial growth. She was given intensive physiotherapy. Her condition improved rapidly over the next two days without any need for assisted ventilation and the tracheostomy tube was removed four days after her operation. There was no other immediate post-operative complication apart from mild pyrexia. She was discharged on the sixth post-operative day." @default.
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• W2039916595 date "2002-02-01" @default.
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• W2039916595 title "Acute tracheitis with severe upper airway obstruction complicating pregnancy" @default.
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• W2039916595 doi "https://doi.org/10.1111/j.1471-0528.2002.00048.x" @default.
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