A Case of Second Twin Fetus with CHAOS Who Underwent Tracheotomy Under EXIT

Ex utero intrapartum treatment (EXIT) is a specialized surgical procedure performed during cesarean delivery to secure the fetal airway, e.g., by tracheostomy, while maintaining umbilical cord circulation. The procedure is indicated for fetuses at risk of severe upper airway obstruction. Here we report, the successful performance of an EXIT tracheostomy for the second twin of a dichorionic diamniotic twin pregnancy diagnosed with congenital high airway obstruction syndrome (CHAOS) at 23 weeks of gestation. Following a comprehensive preoperative evaluation and simulation involving multiple specialties, a scheduled cesarean section with EXIT was performed at 37 weeks and 2 days. The neonate has since had a favorable long-term outcome with no reported airway complications. This case highlights the importance of meticulous preoperative planning and multidisciplinary collaboration in managing complex fetal conditions requiring EXIT. In view of the small number of reported cases of EXIT in twins, this report will contribute to the growing body of literature on this specialized procedure.