{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T16:41:04Z","timestamp":1772728864105,"version":"3.50.1"},"reference-count":14,"publisher":"South African Medical Association NPC","license":[{"start":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T00:00:00Z","timestamp":1664928000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["S Afr Med J"],"abstract":"<jats:p>\r\n\r\n\r\n\r\nCongenital 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\u2019 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\u2019 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.\r\n\r\n\r\n\r\n<\/jats:p>","DOI":"10.7196\/samj.2022.v112i10.16471","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T18:18:36Z","timestamp":1664993916000},"page":"791-794","source":"Crossref","is-referenced-by-count":2,"title":["Medicine and the Law"],"prefix":"10.7196","author":[{"given":"C J M","family":"Stewart","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Peer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Numanoglu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Fieggen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Van Dyk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Bester","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4425","published-online":{"date-parts":[[2022,10,5]]},"reference":[{"key":"4432","doi-asserted-by":"crossref","unstructured":"Hedrick MH, Ferro MM, Filly RA, Flake AW, Harrison MR, Adzick NS. Congenital high airway obstruction syndrome (CHAOS): A potential for perinatal intervention. J Pediatr Surg 1994;29(2):271- 274. https:\/\/doi.org\/10.1016\/0022-3468(94)90331-x","DOI":"10.1016\/0022-3468(94)90331-X"},{"key":"4433","doi-asserted-by":"crossref","unstructured":"Saadai P, Jelin EB, Nijagal A, et al. Long-term outcomes after fetal therapy for congenital high airway obstructive syndromse. J Pediatr Surg 2012;47(6):1095-1100. https:\/\/doi.org\/10.1016\/j. jpedsurg.2012.03.015","DOI":"10.1016\/j.jpedsurg.2012.03.015"},{"key":"4434","doi-asserted-by":"crossref","unstructured":"Nicolas CT, Lynch-Salamon ED, Bendel-Stenzal E, et al. Fetoscopically-assisted percutaneous decompression of the distal trachea and lung reverses fetal hydrops and fetal distress in a fetus with laryngeal atresia. Fetal Diagn Ther 2019;46(1):75-80. https:\/\/doi.org\/10.1159\/000500455","DOI":"10.1159\/000500455"},{"key":"4435","doi-asserted-by":"crossref","unstructured":"Catalano PJ, Urken ML, Alvarez M, et al. New approach to the management of airway obstruction in \u2018high-risk\u2019 neonates. Arch Otolaryngol Head Neck Surg 1992;108(3):306-309. https:\/\/doi.org\/10.1001\/ archotol.1992.01880030094019","DOI":"10.1001\/archotol.1992.01880030094019"},{"key":"4436","doi-asserted-by":"crossref","unstructured":"Bouchard S, Johnson HP, Flake AW, Howell LJ, Myers LB, Adzick NS. The EXIT procedure: Experience and outcome in 31 cases. J Pediatr Surg 2002;37(3):418-426. https:\/\/doi.org\/10.1053\/jpsu.2002.30839","DOI":"10.1053\/jpsu.2002.30839"},{"key":"4437","doi-asserted-by":"crossref","unstructured":"HiroseS,HarrisonMR.Theexuterointrapartum(EXIT)procedure.SeminNeonatol2003;8(3):207-214.","DOI":"10.1016\/S1084-2756(03)00029-0"},{"key":"4438","doi-asserted-by":"crossref","unstructured":"Shimabukuro F, Sakumoto K, Masamoto H, et al. A case of congenital high airway obstruction syndrome managed by ex utero intrapartum treatment: Case report and review of the literature. Am J Perinatol 2007;24(3):197-201. https:\/\/doi.org\/10.1055\/s-2007-972928","DOI":"10.1055\/s-2007-972928"},{"key":"4439","doi-asserted-by":"crossref","unstructured":"Crombleholme TM, Sylvester K, Flake AW, Adzick NS. Salvage of a fetus with congenital high airway obstruction syndrome by ex utero intrapartum (EXIT) procedure. Fetal Diagn Ther 2000;15(5):280- 282. https:\/\/doi.org\/10.1159\/000021022","DOI":"10.1159\/000021022"},{"key":"4440","doi-asserted-by":"crossref","unstructured":"Barthod G, Teissier T, Bellarbi N, et al. Fetal airway management on placental support: Limitations and ethical considerations in seven cases. J Obstet Gynaecol 2013;33:787-794. https:\/\/doi.org\/10.31 09\/01443615.2013.823924","DOI":"10.3109\/01443615.2013.823924"},{"key":"4441","doi-asserted-by":"crossref","unstructured":"Paek BW, Callen PW, Kitterman J, et al. Successful intervention for congenital high airway obstructions syndrome. Fetal Diagn Ther 2002;17(5):272-276. https:\/\/doi.org\/10.1159\/000063179","DOI":"10.1159\/000063179"},{"key":"4442","doi-asserted-by":"crossref","unstructured":"Yaneza MM, Cameron A, Clement WA, et al. An interventional airway delivery service for congenital high airway obstruction. J Laryngol Otol 2015:129(8):795-800. https:\/\/doi.org\/10.1017\/s0022215115000900","DOI":"10.1017\/S0022215115000900"},{"key":"4443","doi-asserted-by":"crossref","unstructured":"Elliott R, Vallera C, Heitmiller ES, et al. Ex utero intrapartum treatment procedure for management of high airway obstruction syndrome in a vertex\/ breech twin gestation. Int J Pediatr Otorhinolaryngol 2012;77:439-442. https:\/\/doi.org\/10.1016\/j.ijporl.2012.11.023","DOI":"10.1016\/j.ijporl.2012.11.023"},{"key":"4444","unstructured":"Botto HA, Boailchuk ID, Garcia C, Decaro M, Aiello H, Copich J. Ex utero intrapartum treatment- management of neonatal congenital high airway obstruction syndrome: A case report. Arch Argent Pediatr 2010;108(4):e92-95. https:\/\/doi.org\/10.1590\/s0325-00752010000400013"},{"key":"4445","doi-asserted-by":"crossref","unstructured":"Nolan HR, Gurria J, Peiro JL, et al. Congenital high airway obstruction syndrome (CHAOS): Natural history, prenatal management strategies, and outcomes at a single comprehensive fetal center. Neonat Fetal Cond 2019;54(6):1153-1158. https:\/\/doi.org\/10.1016\/j.jpedsurg.2019.02.034","DOI":"10.1016\/j.jpedsurg.2019.02.034"}],"container-title":["South African Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/samajournals.co.za\/index.php\/samj\/article\/download\/257\/176","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/samajournals.co.za\/index.php\/samj\/article\/download\/257\/176","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T18:19:45Z","timestamp":1664993985000},"score":1,"resource":{"primary":{"URL":"https:\/\/samajournals.co.za\/index.php\/samj\/article\/view\/257"}},"subtitle":["Fetal intervention (EXIT procedure) for a rare fetal abnormality in a public sector hospital in South Africa \u2013 exploring what is possible"],"short-title":[],"issued":{"date-parts":[[2022,10,5]]},"references-count":14,"URL":"https:\/\/doi.org\/10.7196\/samj.2022.v112i10.16471","relation":{},"ISSN":["2078-5135","0256-9574"],"issn-type":[{"value":"2078-5135","type":"electronic"},{"value":"0256-9574","type":"print"}],"subject":[],"published":{"date-parts":[[2022,10,5]]}}}