Medicine and the Law

C J M Stewart; S Peer; A Numanoglu; K Fieggen; D van Dyk; K Bester

doi:10.7196/SAMJ.2022.v112i10.16471

South African Medical Journal (Oct 2022)

Medicine and the Law

C J M Stewart,
S Peer,
A Numanoglu,
K Fieggen,
D van Dyk,
K Bester

Affiliations

C J M Stewart: Department of Obstetrics and Gynaecology, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa
S Peer: Division of Otolaryngology, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
A Numanoglu: Division of Paediatric Surgery, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
K Fieggen: Division of Human Genetics, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
D van Dyk: Department of Anaesthetics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
K Bester: Division 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

DOI: https://doi.org/10.7196/SAMJ.2022.v112i10.16471
Journal volume & issue: Vol. 112, no. 10

Abstract

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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.

Published in South African Medical Journal

ISSN: 0256-9574 (Print); 2078-5135 (Online)
Publisher: South African Medical Association
Country of publisher: South Africa
LCC subjects: Medicine: Medicine (General)
Website: https://samajournals.co.za/index.php/samj/index

About the journal

Abstract

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