Congenital High Airway Obstruction Syndrome

After CHAOS is fully diagnosed through a formal evaluation, your doctor will explain your treatment options. In severe cases where the fetus has hydrops, fetal surgery to relieve the obstruction may be offered. Hydrops is the build-up of excess fluid, which can be seen in the fetal abdomen, lungs, skin or scalp.

If there is no fetal hydrops, we recommend delivering the baby via the EXIT (Ex Utero Intrapartum Treatment) procedure. The EXIT procedure is for babies who are known to have an airway obstruction. The goal is to provide the baby with a functioning airway so that oxygen can be delivered to the lungs after the baby is separated from placenta.

EXIT procedure

The EXIT procedure is a planned, specialized delivery. It should only be performed at a hospital that can provide a team consisting of a pediatric surgeon, an obstetrician, an anesthesiologist and a neonatologist.

The procedure begins much like a Caesarean section. However, unlike a Caesarean delivery, the mother is put under general anesthesia to ensure that the uterus is completely relaxed.

The baby's head is delivered and the pediatric surgeon passes a bronchoscope through the baby's mouth to look more closely at the airway. Depending on the type of blockage, the surgeon may then attempt to pass a tube through the baby's mouth into the trachea and give breaths to the baby. If this is successful, and oxygen is being delivered to the baby through the tube, the infant is delivered and the umbilical cord cut.

If a tube can't be passed from the mouth through the obstruction, the pediatric surgeon will need to place a tracheostomy tube through the neck directly into the trachea, bypassing the blockage. The surgeon will make an incision in the baby's neck and will place a tube below the airway blockage. Once the tube is placed, and the surgeon is confident that it is functioning and can be used to deliver oxygen to the baby, the infant is delivered.

After delivery via an EXIT procedure, the infant is brought to the Intensive Care Nursery for close observation and further assessment. Additional reconstructive surgeries may be needed.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Intensive Care Nursery
1975 Fourth St., Third Floor
San Francisco, CA 94158
Phone: (415) 353-1565
Fax: (415) 353-1202

Fetal Treatment Center
1855 Fourth St., Second Floor, Room A-2432
San Francisco, CA 94158
Phone: (800) 793-3887
Fax: (415) 502-0660
Appointment information

Surgery Clinic
1825 Fourth St., Fifth Floor, 5B
San Francisco, CA 94158
Phone: (415) 476-2538
Fax: (415) 476-2929
Appointment information