Congenital high airway obstruction syndrome (CHAOS): A potential for perinatal intervention

Hedrick, Marc H.; Ferro, Marcelo Martínez; Filly, Roy A.; Flake, Alan W.; Harrison, Michael R.; Adzick, N. Scott

doi:10.1016/0022-3468(94)90331-x

Cited by 208 publications

(146 citation statements)

References 11 publications

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“…Causes of obstruction include laryngeal atresia, laryngeal web, laryngeal cyst, and tracheal atresia or stenosis. The obstructed airway causes decreased clearance of fluid produced by the fetal lungs as well as an increase in intratracheal pressure resulting in lung hyperexpansion and abnormal development [3,5]. The hyperexpanded lungs cause compression of the heart and inferior vena cava, decreasing venous return and leading to nonimmune hydrops [3,5,6].…”

Section: Discussionmentioning

confidence: 99%

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Prenatal ultrasonography findings of fetus with congenital high airway obstruction (chaos): A case report and review of literature

Ekmekçi¹,

Gençdal²,

Kiziltug³

2017

Clin Obstet Gynecol Reprod Med

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Congenital high airway obstruction syndrome (CHAOS) is an extremely rare life-threatening condition. The sonographic findings are very characteristic. Generally the diagnosis is made with the 4-chamber view of the fetal heart. Typically, both lungs appear severely enlarged and highly echogenic. The heart points towards the midline of the thorax. Fetal ascites is determined commonly on ultrasound examination. A case of CHAOS, diagnosed antenatally via ultrasound is reported here.

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Section: Discussionmentioning

confidence: 99%

“…Laryngeal atresia seems to be the most frequent cause [2]. CHAOS has been considered an almost invariably fatal condition [3] which often goes incorrectly diagnosed until autopsy. Fortunately, more cases can be recognized in utero nowadays, as there are significant technical improvements in prenatal imaging.…”

Section: Introductionmentioning

confidence: 99%

Prenatal ultrasonography findings of fetus with congenital high airway obstruction (chaos): A case report and review of literature

Ekmekçi¹,

Gençdal²,

Kiziltug³

2017

Clin Obstet Gynecol Reprod Med

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“…Congenital high airway obstruction syndrome (CHAOS) is an ultrasonographic antenatal diagnosis comprising extremely large echogenic lungs, pleural or pericardial effusions, a dilated tracheobronchial tree, inverted or flattened diaphragms, fetal ascites with nonimmune hydrops and complete or almost complete upper airway obstruction [10][11][12][13][14]. These findings result from increased intratracheal pressure and distention of the tracheobronchial tree secondary to the accumulation of fluid in the lungs.…”

Section: Discussionmentioning

confidence: 99%

“…Laryngeal atresia, laryngeal web, laryngeal cyst or tracheal atresia may be the causes of airway obstruction. The incidence of CHAOS is rare [10]. Skeletal and vertebral malformations, tracheoesophegeal fistula, esophageal atresia, genitourinary malformations, limb deformities and cardiac malformations are usually associated with CHOAS.…”

Section: Discussionmentioning

confidence: 99%

Placenta Previa Combined with Placenta Accreta and Fetal Congenital High Airway Obstruction- Failed Ex Utero Intrapartum Treatment

Solanki¹

2015

Glob J Anesth

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057within normal limits. Blood pressure was 110/80 mmHg and heart rate was 82/minute. Airway examination revealed mouth opening of 3 cm. She was mallampatti class II with full range of neck movement. Tablet ranitidine 150 mg and metoclopramide 10 mg was given night before surgery and in morning on day of surgery. In the operating room, standard 5 leads ECG, NIBP and pulse oximetry were attached and baseline parameters were noted. Two large bore (16 G) venous cannulae were secured in upper limbs and normal saline infusion was started. ENT and pediatric surgeons were kept ready for surgery and procedures on baby. After preoxygenation with 100% for 5 minute (target endtidal oxygen >90%), rapid sequence anesthesia was induced with IV thiopentone 325 mg and IV suxamethonium 125 mg. Trachea was secured with 7.0 mm ID tracheal tube. IV atracurium 25 mg was given once the effect of suxamethonium was tapered. Anesthesia was maintained with isoflurane in a mixture of oxygen and nitrous oxide (30:70). Right internal jugular central venous catheterization was done and radial artery was cannulated for continuous invasive blood pressure monitoring. Surgical plan was to perform ex utero intrapartum treatment (EXIT) on fetus after classical cesarean incision if the maternal bleeding will be under control. Surgery was allowed to start. Uterus was opened and baby was delivered out. As soon as the baby was delivered profuse bleeding was started from uterus and placenta. It was decided not to perform EXIT procedure and cord was clamped and cut. Bleeding was continued from uterus and placenta. Three units of packed red blood cells and three units of fresh frozen plasma were transfused. Meanwhile ENT surgeon performed tracheostomy on baby and airway was secured but baby died after half an hour. All measures to control the bleeding were failed. Bleeding was continued from uterus and placenta, hysterectomy was done. Blood loss was around 2500 IntroductionPlacental abnormalities like placenta previa and accreta are more common in parturient with prior history of cesarean delivery. They are prone to cause massive bleeding during cesarean and emergency cesarean hysterectomy has to be performed to save the life of mother. If such a condition is associated with fetal airway abnormalities then condition may be even worse. We here describe a case of parturient with placenta previa-accreta and fetal congenital high airway obstruction posted for cesarean section. Case ReportA 26 year old G2P1001 parturient was admitted at 32 weeks of pregnancy for obstetric services. She was a diagnosed case of placenta previa grade III with placenta accreta. Ultrasonography (USG) at 16 weeks of pregnancy showed normal fetal skull, spine and stomach. At 26 weeks of pregnancy USG showed low lying placenta anteriorly covering internal os, moderate to severe fetal hydrocephalus with dilated lateral ventricles (1.9 cm), single upper limb and short other limbs, skeletal dysplasia and over-distended fetal abdomen with large cystic masses. Level II obstetric USG at 28...

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“…[17]. К возникновению симптома приводят врож- Выявление синдрома врожденной обструкции верхних дыхательных путей с 1993 по 2014 г., анализ исследова-ний с выборкой пациентов более 5 человек Detection of CHAOS from 1993 to 2014, analysis of studies with a numbers of patients more than 5 people денные патологии верхних дыхательных путей, при которых возникает частичная или полная об-струкция: атрезия гортани, атрезия трахеи, кисты гортани, новообразования ротоглотки, гортани, шеи.…”

Section: классификация врожденных пороков развитияunclassified

A meta-analysis of prenatal diagnosis of congenital malformations of the airways

et al. 2018

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Congenital malformations of the respiratory tract is an important issue. They cause more than 100 deaths annually in the Russian Federation. The definition and classification of congenital malformations of the respiratory tract are described and developed by Je. A. Cvetkov. The ultrasound is the primal method used in prenatal diagnosis of congenital malformations of the upper respiratory tract. Starting from the age of 17-23 weeks old, the ultrasound shows the following signs: hyperechoic lungs, dilatation of the lower respiratory tract, flattening of the diaphragm. This ultrasound pattern is typical for Congenital High Airway Obstruction Syndrome (CHAOS). If the doctor suspects an identifying of these signs, a follow-up examination is recommended. If the congenital obstruction of the upper respiratory tract is diagnosed during the pregnancy, the childbirth for patients must be performed in the hospital, where it is possible to perform tracheotomy and artificial ventilation of the lungs to the newborn, to operate him with placental support. This type of surgical treatment by the EXIT method (The ex utero intrapartum treatment procedure) is a new stage in neonatal surgery. A meta-analysis of 15 articles in the foreign literature about the detection of CHAOS from 1993 to 2014 was conducted. The analysis includes studies with more than 5 described cases. The statistics of diagnosis and treatment of congenital malformations of the larynx of patients of the ENT clinic of SPbSPMU for the period from 2003 to 2016 with the diagnosis of congenital malformation of the larynx is presented.

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Congenital high airway obstruction syndrome (CHAOS): A potential for perinatal intervention

Cited by 208 publications

References 11 publications

Prenatal ultrasonography findings of fetus with congenital high airway obstruction (chaos): A case report and review of literature

Prenatal ultrasonography findings of fetus with congenital high airway obstruction (chaos): A case report and review of literature

Placenta Previa Combined with Placenta Accreta and Fetal Congenital High Airway Obstruction- Failed Ex Utero Intrapartum Treatment

A meta-analysis of prenatal diagnosis of congenital malformations of the airways

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