Management of antenatally detected fetal airway obstruction

Walker, Paul; Cassey, John; O’Callaghan, Stephen

doi:10.1016/j.ijporl.2005.01.013

Cited by 17 publications

(11 citation statements)

References 20 publications

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“…Although successful intrauterine treatments have been reported, the ex utero intrapartum treatment (EXIT) seems to be the only chance of survival of the affected fetus. The objective of the procedure is to settle an intact airway for the baby before the fetomaternal circulation is stopped (8). Neonatal survival is improved if a well-planned EXIT procedure is performed at the time of a controlled near-term cesarean section (9) therefore prenatal diagnosis has a vital role in these cases.…”

Section: Discussionmentioning

confidence: 99%

Congenital high airway obstruction syndrome (CHAOS): discussing the role and limits of prenatal diagnosis starting from a single-center case series

Vitale¹

2016

JPM

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Objectives: we aimed to report our experience about congenital high airway obstruction syndrome (CHAOS) that is a rare and fatal congenital anomaly; laryngeal atresia is the most frequent cause. Sonographic findings are enlarged echogenic lungs, dilated trachea, and ascites. Methods: we performed a single-center case series analysis collecting antenatally through ultrasound examination, and some of them confirmed by autopsy. Results: we report six cases of CHAOS diagnosed by antenatal ultrasonography between 2007 and 2013. Conclusion: to date literature provides very few individual case reports. This work describes typical sonographic findings of this syndrome and it underlines the importance of early prenatal diagnosis to improve prognosis thought an ex utero intrapartum treatment, that seems to be the only chance of survival for the affected fetus.Key words: congenital high airway obstruction, prenatal diagnosis, diagnosis, prognosis. IntroductionCongenital high airway obstruction syndrome (CHAOS) is an extremely rare congenital anomaly, caused by laryngeal or tracheal atresia, tracheal stenosis, obstructing laryngeal cysts and obstructing tumors of the oropharynx and the cervical region, or rarely by compression from a double aortic arch (1). Laryngeal atresia seems to be the most frequent cause (2). In these cases, an outflow obstruction of the fetal lung fluid leads to pulmonary hyperplasia. Prenatal ultrasound findings are very characteristic and include lungs symmetrically enlarged and highly echogenic, dilated and fluid-filled trachea and bronchi, inverted hemidiaphragms (3). The heart appears small compared with the enlarged lungs and positioned towards the midline of the thorax due to compression by the lungs. Fetal ascites is often present and sometimes hydrops. MethodsWe report our experience of six cases of CHAOS, diagnosed antenatally through ultrasound examination, and some of them confirmed by autopsy.

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Section: Discussionmentioning

confidence: 99%

Congenital high airway obstruction syndrome (CHAOS): discussing the role and limits of prenatal diagnosis starting from a single-center case series

Vitale¹

2016

JPM

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“…However, nowadays, especially if CHAOS due to incomplete obstruction is diagnosed in the late 2nd or in the 3rd trimester and if severe hydrops has not occurred yet, the EXIT procedure (ex utero intrapartum treatment) can be offered. The common objective of the procedure is to settle an intact airway for the baby before the fetomaternal circulation is stopped [9]. …”

Section: Discussionmentioning

confidence: 99%

Prenatal Diagnosis of Congenital High Airway Obstruction Syndrome: Report of Two Cases and Brief Review of the Literature

Ülkümen

Pala

Neşe

et al. 2013

Case Reports in Obstetrics and Gynecology

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Congenital high airway obstruction syndrome (CHAOS) is the obstruction of the fetal upper airways, which may be partial or complete. It is usually incompatible with life. Prenatal recognition of the disease is quite important due to the recently described management options. We report here two cases of CHAOS due to tracheal atresia diagnosed by antenatal ultrasonography and fetal MRI. We also briefly review the relevant literature with the associated management options.

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“…The majority of isolated lesions causing airway obstruction, with the exception of complete tracheal agenesis, which has no reported survivors, have an excellent prognosis with appropriate treatment (2–5) However, if these lesions are undetected antenatally and delivery unplanned, it can be impossible to establish an airway and the outcome is often severe hypoxia and death. With widespread antenatal imaging, identification of potential airway compromise is becoming more common, availing us of the opportunity to plan appropriate perinatal airway management and hence to improve outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Antenatal assessment of the location, size and structure of a mass is, in many cases, effectively achieved by detailed USS (2,5,6) and USS alone can be diagnostic. Once an abnormality is identified, regular USS are necessary to monitor the size of the lesion, liquor volume and placental position as well as to look for complications, such as hydrops fetalis, which carry a worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

Four cases of congenital airway obstruction: optimising perinatal management

et al. 2007

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Congenital anomalies causing airway obstruction in the newborn are potentially fatal. However if an effective airway can be maintained the long-term prognosis is often excellent. We present four cases of airway obstruction, three of which were diagnosed antenatally. We discuss the role of antenatal imaging and review delivery options including the need for a multidisciplinary team approach. In conclusion, we recommend antenatal imaging with both ultrasound scan and magnetic resonance to inform perinatal management. Polyhydramnios, in association with suspected neonatal airway obstruction, should alert clinicians to a high-risk situation. We recognize that even in skilled hands, securing an airway can be very difficult and alternatives such as maintenance of the fetomaternal circulation or extra-corporeal life support should be considered.

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Management of antenatally detected fetal airway obstruction

Cited by 17 publications

References 20 publications

Congenital high airway obstruction syndrome (CHAOS): discussing the role and limits of prenatal diagnosis starting from a single-center case series

Congenital high airway obstruction syndrome (CHAOS): discussing the role and limits of prenatal diagnosis starting from a single-center case series

Prenatal Diagnosis of Congenital High Airway Obstruction Syndrome: Report of Two Cases and Brief Review of the Literature

Four cases of congenital airway obstruction: optimising perinatal management

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