In carefully selected cases, I may recommend fetal surgery before birth to relieve your baby’s airway obstruction. Using a fetoscope, a thin camera inserted into the uterus, I can work with our multidisciplinary fetal therapy team to evaluate and, when possible, treat the blockage while your baby is still in the womb. Depending on the cause of the obstruction, I may first perform a fetal bronchoscopy to determine whether it is caused by a simple laryngeal web or cyst, which can sometimes be treated immediately. For more complex airway blockages, specialized techniques such as laser perforation of the obstructed larynx or trachea may be considered. In rare situations, if the airway is blocked by thick cartilage, a fetal tracheostomy may be necessary to create an opening that allows your baby to breathe. Although most babies will still require an EXIT (Ex Utero Intrapartum Treatment) procedure at delivery, relieving the obstruction before birth can reduce complications such as hydrops fetalis, improve your baby’s condition, and make care after delivery safer and more effective.
Because fetal intervention for CHAOS is highly specialized, I carefully evaluate whether the potential benefits outweigh the risks for you and your baby. While fetal surgery has shown promising results, researchers are still learning about its long-term effects on lung development and overall outcomes. In some pregnancies, if your baby remains stable and we can monitor you closely with frequent ultrasound examinations, I may recommend delaying intervention until after 30 weeks of pregnancy, when an EXIT procedure can be performed with a lower risk associated with prematurity.