UP-PGH team achieves PHL’s first successful EXIT delivery of baby

The first completed Ex Utero Intrapartum Treatment (EXIT to Airway) in the country was successfully performed at the Philippine General Hospital, University of the Philippines Manila on November 4, 2015 on 25-year-old Crishilda and her baby, Crislyn Faith, who had Congenital High Airway Obstruction (CHAOS) due to a huge lymphatic-venous malformation (cystic hygroma) that covered her cheek, chin, and neck, extending into the base of her tongue and throat and compressing her airway.

Delivery even by caesarean section could have meant failure to take her first breath if her airway could not be established in time—a baby with a similar malformation died last year under these circumstances.

To circumvent this, a caesarean section was performed to deliver only the head and neck, while maintaining the body on fetal-maternal circulation inside the uterus. The tumor prevented insertion of a breathing tube through her mouth, despite removal of 190cc of blood and lymph from the impinging mass. A surgical airway (tracheostomy) urgently had to be created through the neck while the baby was still attached to her mother through the placenta, before the baby was fully delivered.

Both mother and child are alive and well, thanks to the multi-disciplinary team from the Departments of Obstetrics and Gynecology, Otorhinolaryngology, Anesthesiology, Pediatrics, Radiology and the Operating Room Complex, led by Dr. Valerie Guinto and Dr. Ireene Cacas (Maternal-Fetal Medicine), Dr. Jose Florencio Lapeña (Pediatric Otolaryngology Head and Neck Surgery), Dr. Loreto Fellizar, Dr. Carlo Catabijan, Dr. Eric Bandola and Dr. Kai Espejo (Anesthesiology), Dr. Rosanna Fragante (Radiology), Dr. Resti Ma. Bautista, Dr. Fay De Ocampo (Neonatology), Chief Nurse Juliet Mangahis (OR Complex), and Perinatology Fellow Dr. Pauline Lim-Reyes, with Fellows, Residents and Nurses from the involved departments, and support from the Department of Health and PGH Medical Foundation.

Press release from the Philippine General Hospital