An eight-month-old pre term baby delivered by emergency Caesarean section with an “EXIT procedure” is doing well at 2.5 months of life.
Oct 09: A 24-year-old homemaker and her spouse, hailing from Nagaland, were eagerly waiting to travel to their hometown Howrah for the delivery of their first child. A routine 5th month ultrasound report overshadowed their joy with anxiety. The pregnancy had been uneventful till date, however, the present ultrasound showed that the baby had developed fluid accumulation in both lung cavities.
Overwhelmed by uncertainty about the baby’s future, the couple travelled early for a thorough evaluation at their hometown.
In Narayana Hospital Howrah, the lady underwent evaluation and tests were done to rule out structural, genetic abnormalities & in-utero (in the womb /uterus) infections in the baby. The couple was explained in detail about the condition, need for close surveillance for the baby’s health and the possibility of worsening of the fluid collection during ongoing pregnancy.
In her 31st week of pregnancy, she went into preterm labour with a sudden increase in fluid around the baby. She was started on medications to arrest preterm labour to buy time for medications for the baby to ensure lung maturation and neuroprotection in view of preterm delivery.
In view of the rarity of the problem, the hospital drew up a team of specialists, which included Dr. Sumana Datta (Consultant Gynaecologist & Obstetrician), Dr. Akhileshwar Narayan Chowdhury (Consultant Paediatrician & Neonatologist), Dr. Goutam Chakraborty (Consultant Paediatric & Neonatal Surgeon) and Dr. Rashmi Shahi (Consultant Anaesthesiologist).
A decision for emergency Caesarean section with EXIT procedure was taken, as the baby would not be able to breathe normally after birth due to pressure effect of fluid around the lungs.
EXIT, or Ex-Utero Intrapartum Treatment, is a specialised procedure conducted in rare high-risk cases where securing the baby’s airway in utero becomes imperative prior to completion of delivery, during which additional surgical procedures for safety of the baby can be undertaken.
The fetus had developed a life threatening condition called Hydrops fetalis where there was enormous collection of fluid in the chest and abdomen thus making the fetus unable to breathe and maintain blood circulation on its own after being taken out of the mother's womb. It meant that the doctors had to intervene while the baby is still surviving on mother's blood via the umbilical cord and all steps would need to be completed within a few minutes. Hence, when the baby was taken out of the uterus but still attached to the mother's womb by the umbilical cord, the doctors secured the breathing by putting a tube and simultaneous drainage of massive fluid collection from the chest by other tubes.The situation was extremely tense and challenging with Oxygen saturation going down to zero for a few seconds. But a rapid sequence coordination from all doctors revived the baby just in time.
The baby had a turbulent stay in Newborn Intensive Care Unit for almost a month before getting discharged. In follow up,the baby was found to be doing well and gaining weight. This shows Narayana Health's commitment towards excellent mother & baby care and the importance of a multidisciplinary approach.
Presently the baby is doing well and gaining weight at 2.5 months of life.
EXIT procedure maintains good oxygen saturation in baby via intact umbilical circulation as the baby is partly delivered out of the womb (uterus) while procedures are undertaken to establish airway and additional surgical procedures are undertaken.
EXIT procedure, being a rare specialised procedure, needs a good interdisciplinary team who work to optimise fetal and maternal outcomes.
EXIT procedures have been performed in only a few centres in India & this is the first in our state.