A multi-departmental medical team at PSG Hospitals in the city has done a complicated procedure of providing assisted breathing for a male baby while removing it from the uterus and then removing a 12-cm lymph cyst that extended from ear to ear.

Rare case

The team consisting of obstetricians and gynaecologists, paediatricians and paediatric surgeons and anaesthetists decided to do a caesarean as the foetus' neck was too swollen with the cyst for a normal delivery.

“This is a rare case that was managed well with excellent team work,” says Medical Director (Super Speciality) of the hospital J.S. Bhuvaneswaran.

The cyst was choking the airway and the baby faced the risk of dying soon after birth. Therefore, the child had to be put on assisted breathing before cutting the umbilical cord. “We call this procedure ‘EXIT' (ex-utero intra-partum treatment), which enables rescue of the child and the mother,” explains obstetrician and gynaecologist T.V. Chitra, a core team member that carried out the procedure.

It was quite fortuitous for the child's 29-year-old mother Umadevi that she underwent a scan just 10 days before the predicted date of labour. Normally, the scan is done in the fifth and eighth months of pregnancy.

The scan done at Karur and another at Erode revealed a large growth in the neck and the woman was referred to PSG Hospitals. A quick, yet detailed, assessment of the situation was made and the team got to work. In addition to Dr. Chitra, the other three components the multi-department team were headed by A. Pavai (paediatric surgery), Sarah Paul (paediatrics) and Mushahida (anaesthesiology).

The woman's uterus was opened and the baby was taken out up to the neck while the rest of its body was still inside. The child was first put on assisted breathing. “Only then could we cut the umbilical cord, the life source for the foetus while in the uterus,” says Dr. Pavai.

Immediately after the assisted breathing (intubation) was established, the umbilical cord was cut, the baby removed from the uterus and so was a substantial portion of the lymph cyst.

Risk

The doctors say that this procedure involves a lot of risk for the mother. The uterus has to be kept open for as long as the assisted breathing is fully established. Normally, the uterus must be allowed to contract immediately after delivery. Prolonged expansion can lead to heavy bleeding.

“The success of this procedure should be attributed to a strong and experienced Foetal-Maternal Unit in our hospital. Only this kind of a multi-disciplinary unit can manage such cases,” says Dr. Pavai.

“We have removed most of the lymph cyst. The portions near the ears were not removed as vital blood vessels passed through this region. After six months, the cyst on either side near the ear can be shrunk through sclerotherapy (with injections),” she says.

Keywords: PSG Hospitals