A baby, who was diagnosed with enlargement of thyroid gland in utero, was intubated half-way through a caesarean section recently. Multidisciplinary teams of doctors came together to perform EXIT (ex utero intrapartum treatment) procedure on the baby soon after he was delivered up to the head with the umblical cord intact to ensure oxygen supply from the mother.
The 23-year-old mother was referred from Seethapathy Clinic and Hospital to MediScan Systems after an ultrasound in her 28th week of pregnancy revealed that the foetus had a swelling in the front of the neck.
“It was a routine scan to assess the size of the baby when we picked up the neck swelling along with slight increase in the fluid around the baby,” Uma Ram, director of the hospital, said. S. Suresh, foetal medicine specialist and director of MediScan Systems said it was suspected that the thyroid gland was enlarged. “We tested the fluid around the baby and did foetal blood sampling. We confirmed that it was due to hypothyroidism,” he said.
The baby was treated in utero and two intra-amniotic injections of thyroxine was given at an interval of 10 days. At 36 weeks, a foetal MRI showed that the swelling was compressing the trachea (airway) and oesophagus. “If delivered, the baby will have difficulty in breathing as the trachea is obstructed. When we clamp the umbilical cord, oxygen supply from the mother will be cut off. So, we have a small window period of a minute during which the baby must get oxygen,” he explained.
Multidisciplinary teams of doctors decided to perform EXIT procedure at Dr. Mehta’s Hospitals. “In EXIT, the baby is still connected to the mother’s placenta to receive oxygen. The procedure is recommended not only for babies with thyroid swelling but also upper chest swelling as the airway is likely to be compromised. We delivered the baby upto the head and the endotracheal tube was put in place. The umblical cord was then cut,” Dr. Uma Ram added. The neonatal team from Dr. Mehta’s Hospitals comprised doctors Lakshmi and Jayanthi, a press release said.