Life-threatening airway obstruction due to upper airway edema and marked neck swelling after labor and delivery

Abstract

Background and objectives: Airway changes generally occur in normal gravidas; however, these changes could cause critical situations in specific populations. Objectives: This article presents the case of a difficult airway patient that went into shock because of atonic bleeding after vaginal delivery for stillbirth. Case report: A 32-yr-old woman with atonic bleeding after vaginal delivery for stillbirth was transferred to our hospital. She manifested shock, and her respiratory condition was progressively deteriorating. Airway obstruction caused by neck swelling and pharyngolaryngeal edema was apparent. We tried tracheal intubation using direct and indirect laryngoscopes. However, it turned out that insertion of the laryngoscopic devices to the oral cavity was impossible. After several attempts using the Trachlight™, successful intubation was finally made. After hysterectomy, she was admitted to the intensive care unit (ICU) and treated for five days. At discharge from the ICU, her Mallampati score was I-II. Her body weight decreased 60 kg to 51 kg during ICU stay. Conclusions: We believe that concomitant attacks of labor and delivery and fluid resuscitation probably worsened upper airway and neck edema enough to cause acute airway obstruction and difficult laryngoscopy. Keywords: Labor and delivery, Difficult airway, Airway edema