Role of Fetal Laryngoscopy in Prenatal Counseling for Fetuses With Congenital High Airway Obstruction Syndrome: A Case Report and Review of the Literature

Congenital high airway obstruction syndrome (CHAOS) is a rare, life-threatening condition involving complete or near-complete airway obstruction. Fetal laryngoscopy enables direct airway endoluminal visualization of the airway, thereby complementing prenatal imaging to enhance diagnosis and counseling. In this case, CHAOS was diagnosed at 17 weeks of gestation following ultrasound and fetal magnetic resonance imaging, which revealed tracheal dilation and echogenic lungs. Diagnostic fetal laryngoscopy performed at 24 weeks demonstrated a blind-ended trachea that was not amenable to fetal decompression. Despite counseling regarding the limited feasibility of airway establishment, emergent delivery with an ex utero intrapartum treatment (EXIT) procedure was performed at 30 weeks. Airway establishment was unsuccessful, and the neonate died shortly after birth. Significant maternal hemorrhage occurred after delivery, requiring transfusion. This case underscores the complexity of prenatal counseling and family-centered decision-making. Fetal laryngoscopy may be considered an adjunct to improve diagnostic evaluation and counseling, potentially aiding prenatal decision-making in selected cases of CHAOS.