Doctors at Yale New Haven Children’s Hospital Fetal Care Center performed surgery on a baby girl who was partially delivered earlier this year after a mass — a benign teratoma — was discovered on her neck. It was compressing her airways, and doctors believed she may not be able to breathe at birth unless they acted to help her. The baby girl was safe in her mother’s womb, but that would change when she was born and was no longer receiving her oxygen through the placenta.
At 26 weeks, Elianna Rodriguez’s mother, Summer Rodriguez, 22, knew something was wrong. Elianna was measuring at 32 weeks due to extra amniotic fluid in her mother’s womb. Doctors discovered Elianna was unable to swallow the amniotic fluid, which had begun to build up in Rodriguez’s uterus. When doctors informed Rodriguez and her husband Ruben of the mass and explained that Elianna would need to undergo a procedure while she remained partially in the womb, they were afraid.
“It was scary, and it was very overwhelming. We were not prepared to hear something like that because, prior to that … she was healthy. So we were definitely not prepared to hear that information,” said Rodriguez.
She added, “I cried for a very long time. I felt like I was hit by a train when I heard the way that she had to be delivered, because my first son was delivered also via emergency C-section, and I was put to sleep with him. So the one thing I didn’t want was to be put to sleep.”
But, in order to keep her uterus from contracting, Rodriguez would have to be put under anesthesia.
The Hartford Courant reported that the procedure Elianna needed is called ex utero intrapartum treatment, or EXIT, during which doctors keep the baby in an environment that is as close to being in the womb as possible. Elianna’s head and shoulders would be brought outside of her mother’s uterus while the rest of her body remained in the uterus with the placenta attached.
Elianna was scheduled to have the surgery and be delivered on June 9, but then doctors realized the procedure would need to be done sooner, moving it to May 25. Dr. Mert Ozan Bahtyar, co-director of the Fetal Care Center, carried out the life-saving procedure on the baby girl at 35 weeks in which Elianna was partially delivered so that doctors could insert a breathing tube in her trachea before fully delivering her.
“With a neck mass … the concern is that when the baby goes to take their first breath, they’re going to be in trouble,” he said. “They’re fine when they’re hooked up to the umbilical cord. They’re getting all the nutrients and all the carbon dioxide exchanged through the umbilical cord at the present. But the concern is, when that baby goes to take a first breath, their airway is occluded,” explained Dr. David Stitelman, surgical director of the Fetal Care Center.
Once Elianna was partially delivered, doctors had a window of 30 to 45 minutes to complete the procedure in order to avoid brain damage.
“That’s a coordinated effort with OB (obstetrics), anesthesiology to monitor the mother, pediatric anesthesiology and maternal fetal medicine to monitor and support the fetus … and surgery to help open up the uterus,” Ear, nose, and throat specialists then insert a breathing tube, allowing Elianna to breathe on her own outside the womb.
Two weeks later, the mass was removed from Elianna’s neck and she is now a healthy little girl.
