When the anaesthetist put Angelica Vance under for her caesarean section, she had no way of knowing what she’d encounter when she woke.
If everything went perfectly, the baby would be on a ventilator and the doctors would have a plan to remove the growth that was impairing her daughter’s breathing.
If things went wrong, Vance might be recovering from severe bleeding, while a machine pump-ed blood through her daughter Chloe’s body.
“If ECMO didn’t work, she wouldn’t make it,” Vance said of the blood-pumping machine called extracorporeal membrane oxygenation.
“That morning was intense.”
A dangerous growth
Vance, of Fort Collins, Colorado, United States, said her third pregnancy had progressed relatively normally until the final trimester.
That was when pain and a jump in the circumference of her belly pointed to an excessive build-up of amniotic fluid.
Her doctor removed two litres of fluid and kept her for further testing, because an increase that fast usually points to a bigger problem, she said.
An ultrasound and MRI (magnetic resonance imaging) found a growth in the baby’s chest and neck.
This growth was keeping her from swallowing amniotic fluid and would also prevent Chloe from taking her first breath after being born.
While a baby is inside and supported by the placenta, breathing isn’t a concern, because the mother supplies oxygen through the umbilical cord, said Children’s Hospital Colorado paediatric and fetal surgeon Dr Chris Derderian, who treated Vance and Chloe.
Once the placenta detaches from the uterine wall, the baby needs to breathe on their own, giving a relatively tight window to open the airway, he said.
He offered Vance an ex-utero intrapartum treatment (EXIT) procedure.
During this procedure, he would partially deliver Chloe via caesarean section, and a team would work to open her airway while she remained attached to her mother.
The procedure is relatively risky because the anaesthetist has to give medication to relax the uterus, preventing the placenta from tearing loose, but increasing the odds of serious bleeding.
The hospital only performs about one EXIT procedure each year.
These are in cases where the baby has no other options, but has a good enough chance of survival that the hospital can give the family a choice whether to accept the risks, he said.
A smooth delivery
After Vance went under general anaesthesia on Oct 15 (2024), Dr Derderian and his team delivered Chloe’s head and shoulders by caesarean section.
That started a clock of about 90 minutes that the placenta could act as life support.
About 40 people from various specialities crowded into the room in case they needed to handle possible complications, including a cardiac surgeon who could open the baby’s chest if the growth put too much pressure on her lungs.
The airway was about the width of the tip of a pen, so the emergency medical technicians inserting the breathing tube had to use one that would push back against the pressure from the growth, Dr Derderian said.
At that point, they had no way of knowing whether the airway was open, however slightly, through its full length or was completely closed at some point.
If it was closed, they’d have to cut a hole in her neck to insert the tube.
And then, in about 15 minutes, the worst was over.
The tube went down and Chloe turned pink as the ventilator pushed oxygen into her body.
Some of the specialists dispersed, while others took Chloe to the neonatal intensive care unit or sewed up Vance and prepared for her to wake.
“I don’t think we have got a better scenario,” Dr Derderian said.
A progressive recovery
When Vance woke up, she learned that the hospital had planned another surgery to remove the growth once Chloe was three days old.
That also went better than she feared, taking about two hours instead of the six that the doctors projected, she said.
The growth wasn’t cancerous, and it hadn’t wrapped too tightly around her daughter’s airway, making removal easier.
Chloe spent about 10 days on a ventilator before transitioning to less-invasive oxygen support, Vance said.
After six weeks in the neonatal intensive care unit, Chloe went home without oxygen, though she did need a feeding tube because of difficulty swallowing, said Vance.
Fetuses essentially practise breathing and swallowing during the third trimester, and the mass around her neck limited that preparation.
Now, Chloe is relatively healthy, though she still receives therapy every day to work on her swallowing and to build up her neck muscles, Vance said.
Vance explained that she wanted to speak about her experience because she’d never heard of a mother who went through the same thing, and at the beginning, their family’s future looked bleak.
“It feels like playing a lot of catch-up, but she has come a long way,” Vance said.
“It helps you to see something positive.” – By Meg Wingerter/The Denver Post/Tribune News Service
