Tracheal plugs in oligohydramnios.

Obstruction of the tracheobronchial tree in the fetus-newborn is well recognized with meconium-stained amniotic fluid, but this problem is not usually considered in the absence of meconium. In the case reported here, airway obstruction by a large mucous-like plug apparently developed in the context of severe oligohydramnios and fetal distress. The infant required resuscitation but it was initially impossible to expand the chest despite endotracheal intubation and positive pressure ventilation. The lung compliance changed abruptly at 6 minutes of age and breath sounds were audible unilaterally on the left. A chest radiograph confirmed an atelectatic right lung. After aspiration of a large plug, both lungs became normally aerated. Airway obstruction must be included in the differential diagnosis of respiratory distress occurring in the context of severe oligohydramnios.