Airway Emergency in a Primigravida Associated With Paradoxical Vocal Fold Motion and Placental Abruption Leading to Emergent Cesarean Delivery: A Case Report.

BACKGROUND Paradoxical vocal fold motion disorder (PVFM) is a rare condition consisting of episodic upper airway obstruction, resulting in recurrent stridor and respiratory distress. Limited data exists regarding its presentation, implications, and consequences during pregnancy. In this report, we present the case of a 23-year-old primigravida woman with known PVFM and recurrent stridor who developed acute respiratory distress requiring endotracheal intubation, followed by emergency bedside cesarean delivery, during which an incidental placental abruption was identified. CASE REPORT A 23-year-old primigravida woman with known history of PVFM underwent bilateral vocal fold botulinum toxin injections. She was re-admitted one week after being discharged with recurrent stridor, which temporarily responded to symptomatic management. However, she subsequently developed acute respiratory distress necessitating intubation. She then required emergency bedside cesarean section in the intensive care unit (ICU) for non-reassuring fetal heart tones, in which a placental abruption was incidentally discovered. CONCLUSIONS This case highlights the potential for pregnancy-related anatomic and physiologic airway changes to exacerbate PVFM, creating challenges for emergency airway management in non-operating room settings. It also suggests an association between acute-on-chronic PVFM episodes and placental abruption. We conclude that pregnant patients with PVFM must be monitored closely and considered to be at increased risk for difficult emergency airways and maternal respiratory distress than can lead to placental abruption.