Medicine and the Law
Congenital 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 terminatio...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
South African Medical Association
2022-10-01
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| Series: | South African Medical Journal |
| Subjects: | |
| Online Access: | https://samajournals.co.za/index.php/samj/article/view/257 |
| _version_ | 1797334334206640128 |
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| author | C J M Stewart S Peer A Numanoglu K Fieggen D van Dyk K Bester |
| author_facet | C J M Stewart S Peer A Numanoglu K Fieggen D van Dyk K Bester |
| author_sort | C J M Stewart |
| collection | DOAJ |
| description |
Congenital 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.
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| first_indexed | 2024-03-08T08:19:20Z |
| format | Article |
| id | doaj.art-5f2728e946d844788a4bd47203fabf3c |
| institution | Directory Open Access Journal |
| issn | 0256-9574 2078-5135 |
| language | English |
| last_indexed | 2024-03-08T08:19:20Z |
| publishDate | 2022-10-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj.art-5f2728e946d844788a4bd47203fabf3c2024-02-02T06:30:39ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352022-10-011121010.7196/SAMJ.2022.v112i10.16471261Medicine and the LawC J M Stewart0S Peer1A Numanoglu2K Fieggen3D van Dyk4K Bester5Department of Obstetrics and Gynaecology, University of Cape Town, and Groote Schuur Hospital, Cape Town, South AfricaDivision of Otolaryngology, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South AfricaDivision of Paediatric Surgery, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South AfricaDivision of Human Genetics, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Anaesthetics, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDivision of Paediatric Anaesthesia, Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa Congenital 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. https://samajournals.co.za/index.php/samj/article/view/257Fetal interventionEXIT procedure |
| spellingShingle | C J M Stewart S Peer A Numanoglu K Fieggen D van Dyk K Bester Medicine and the Law South African Medical Journal Fetal intervention EXIT procedure |
| title | Medicine and the Law |
| title_full | Medicine and the Law |
| title_fullStr | Medicine and the Law |
| title_full_unstemmed | Medicine and the Law |
| title_short | Medicine and the Law |
| title_sort | medicine and the law |
| topic | Fetal intervention EXIT procedure |
| url | https://samajournals.co.za/index.php/samj/article/view/257 |
| work_keys_str_mv | AT cjmstewart medicineandthelaw AT speer medicineandthelaw AT anumanoglu medicineandthelaw AT kfieggen medicineandthelaw AT dvandyk medicineandthelaw AT kbester medicineandthelaw |