• C J M Stewart, S Peer, A Numanoglu, K Fieggen, D Van Dyk, and K Bester.
• Department of Obstetrics and Gynaecology, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa. Chantal.Stewart@westerncape.gov.za.
• S. Afr. Med. J. 2022 Oct 5; 112 (10): 791794791-794.

AbstractCongenital high airway obstruction syndrome (CHAOS) is a rare condition that can be diagnosed antenatally by ultrasound. It is usually lethal without immediate intervention at delivery. A 24-year-old woman was diagnosed with fetal CHAOS at 27 weeks' gestation. The couple declined termination of pregnancy. A multidisciplinary team including obstetricians, geneticists, paediatric surgeons, neonatologists and anaesthetists was constituted to plan an ex utero intrapartum treatment (EXIT) procedure. After several simulations, a caesarean section was performed at 38 weeks' gestation under deep inhalational anaesthesia. The fetus was fully delivered with placenta remaining in utero to maintain perfusion. A surgical airway was established via tracheostomy in approximately 5 minutes. The operation was then completed with no maternal complications. The child remains well at 3 years of age. To our knowledge, this is the first EXIT procedure performed for CHAOS in the public sector. This procedure can be lifesaving and is possible with proper planning.

18 keywords...

hide…