At Orlando Health’s Winnie Palmer Hospital, a team of surgeons pulled off a rare, high-stakes operation that left baby Cassian effectively “born twice.” At about 25 weeks of pregnancy, doctors partially delivered his head and upper body so they could create an airway, then placed him back into the uterus so he could keep getting oxygen from the placenta. At 31 weeks, they completed a full delivery. Cassian is now home with his parents, although doctors say he will still need more surgeries and long-term respiratory care as he grows.
How surgeons created an airway at 25 weeks
With ethics oversight in place and the family’s consent, the Orlando team performed a variation of an ex utero intrapartum treatment. During a C-section, surgeons expose only the fetus’s head, neck, and shoulders, then place a catheter or tracheostomy to bypass the blocked windpipe. After securing that airway, they closed the uterus again so Cassian could remain attached to the placenta and continue developing inside the womb.
About six weeks later, when his mother went into labor, the same team returned to the operating room, removed the fetal catheter, placed an intubation tube instead, and completed a conventional delivery. Reporters detailed the stepwise 25-week intervention and the later airway exchange in coverage of the case by Live Science.
A family pushed for a chance
Parents Keishera and Greg Jouvert were first told their baby had little to no chance of survival after a midpregnancy scan revealed a thick membrane blocking his airway. The diagnosis was congenital high airway obstruction syndrome, or CHAOS. According to WESH, doctors initially tried a less invasive laparoscopic procedure around 22 weeks, aiming to puncture the membrane from inside the uterus. When that attempt failed, the clinicians and the family agreed to pursue the far riskier partial delivery strategy.
The local team credited the Jouverts’ persistence, along with a carefully choreographed plan that brought together fetal surgery, ear, nose, and throat, and neonatal specialists for the two-stage effort.
Why CHAOS is so dangerous
CHAOS stems from a severe blockage of the fetal upper airway. It can be caused by laryngeal or tracheal atresia, a membrane like the one seen in Cassian’s case, or a mass. The blockage prevents normal lung fluid from escaping, which leads to massively enlarged lungs that do not function properly and can compress the heart, a combination that is often fatal.
Medical literature describes CHAOS as exceedingly rare and historically fatal unless an airway is secured at birth. Published outcomes rely mostly on individual case reports and small patient series, and prenatal EXIT procedures or fetoscopic decompression are the main rescue strategies discussed in recent reviews. For background on CHAOS and prenatal airway approaches, see a case review in PubMed Central and a narrative review of EXIT procedures.
Where Cassian stands now
The Jouverts say Cassian is home and slowly gaining ground, though he still needs respiratory support at times and is not out of the woods. He is expected to undergo at least three more surgeries before his second birthday to thin the membrane in his airway and, if all goes well, work toward coming off a ventilator, according to WESH.
Dr. Emanuel Vlastos and the Orlando team plan to present their experience at an international medical meeting in Japan this October. They hope sharing the details will help other centers think through the risks and potential benefits of similarly early interventions.
A narrow win for fetal surgery, and a call for data
Outside, fetal surgery experts have praised the Orlando group’s meticulous planning, but they are also quick to point out that one dramatic success story is not enough to rewrite the rulebook. One specialist quoted by Live Science said that procedures like this really should be evaluated in clinical trials that track lung and tracheal development, as well as long-term outcomes.
Orlando Health’s fetal program has expanded its in utero offerings in recent years, and the group says that multidisciplinary depth made this staged approach possible. Even so, specialists caution that much broader evidence will be needed before this kind of high-risk rescue can move from a one-off success to anything resembling standard practice.
