By: Akanksha
In Narayan Hospital, Howrah, a team of doctors have performed a rare surgery, Ex-Utero Intrapartum, on a child suffering from Hydrops fetalis. The fetus was delivered only partially through a C-section and still drawing life through her mother’s placenta.
Dr Goutam Chakraborty told Times of India that they operate on newborns after the completion of the delivery, but in this case they would have lost the baby if they waited for completion of delivery.
The father was posted in Nagaland and is originally from Howrah. Because of medical findings, the couple traveled back home to Howrah early for a thorough evaluation.
The 24-year-old mother underwent a thorough examination at Narayan Hospital, Howrah, to rule out structural or genetic abnormalities and in utero infections in the fetus.
The fetus was diagnosed with Hydrops Fetalis — a condition where a fluid-build up in the chest and abdomen or other tissues.
The physicians explained the condition to the couple, emphasizing the requirement for close surveillance for the baby’s health and the risk of progression of the fluid accumulation as the pregnancy continued.
In her 31st week, she went into preterm labor with a sudden increase in fluid around the baby, in her 31st week. She was started on medications to prevent labor to make time for the baby for lung maturation and neuroprotection in view of the anticipated preterm delivery.
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Hydrops fetalis is severe edema (fluid buildup) in an unborn baby or newborn. It is a life-threatening condition.1,2
The condition is categorized based on its underlying causes into two primary types:
Immune hydrops: This type is less common today and typically develops due to the Rh incompatibility between the mother and the child. If the fetus' immune system can not compensate for the resulting severe anemia, heart failure occurs, leading to extensive fluid accumulation in the tissues and body cavity.1
Non-immune hydrops: This is the common form, accounting for cases where maternal blood group incompatibility is not the cause.1,2 It includes conditions that interrupt fetal blood regulation, including:
Severe anemia
Congenital Infections (infections present before birth)
Congenital heart or lung defects
Chromosomal abnormalities and birth defects
Liver disease
Twin to twin transfusion (TTTS)
During pregnancy,
Excessive amniotic fluids (polyhydramnios)
A thickened, edematous placenta
Ultrasound findings showing an enlarged liver, spleen or heart (cardiomegaly), as well as fluid accumulation in the abdomen (ascites), heart sac (pericardial effusion), or lung space (pleural effusion)
After Birth2
Pale appearance
Severe, widespread edema, particularly in the abdomen
Severe respiratory distress
Enlarged liver and spleen (hepatosplenomegaly)
Hydrops are mostly diagnosed during pregnancy or right at birth. During pregnancy the following tests are performed:
Targeted Ultrasound: Visualizes fetal blood flow, structural abnormalities and fluid accumulation in organ spaces.
Percutaneous Umbilical Blood Sampling (PUBS): Draws fetal blood directly from the umbilical cord to check for anemia, blood type, and infections.
Amniocentesis: Samples amniotic fluid to screen for chromosomal abnormalities, genetic conditions and congenital infections.
Prenatal treatment depends on the underlying cause; intrauterine fetal blood transfusions may be performed for severe anemia or immune hydrops, and in many cases, early delivery is required.1
Neonatal management typically involves:
Immediate respiratory support: Mechanical ventilators and supplemental oxygen.1,2
Therapeutic fluid drainage: thoracentesis, paracentesis, or pericardiocentesis using fine needles to relieve fluid pressure compressing the lungs, heart, or abdominal organs.1
Intensive medical therapy: Inotropic support, treatment of underlying metabolic or cardiac issues and exchange transfusions if indicated. 2
Due to the severity and rarity of the problem, the hospital assembled a multi-disciplinary team of specialists: Dr. Sumana Datta (gynecologist and obstetrician), Dr. Akhileshwar Narayan Chowdhury (pediatrician and neonatologist), Dr. Goutam Chakraborty (pediatric and neonatal surgeon) and Dr. Rashmi Shahi (anesthesiologist).
If the surgery team had delivered the fetus via a standard cesarean (C-) section without immediate intervention, the fetus would have suffered acute respiratory collapse from pulmonary compromise.
To prevent this, the team performed an Ex-Utero Intrapartum Treatment (EXIT) procedure. During this complex operation, the fetus was delivered only partially through the uterine incision while remaining fully supported by placental circulation.
Over a focused 40-minute operation, the specialists stabilized the infant while she partially remained in utero. They placed three percutaneous tubes into her tiny body, draining the fluids suffocating her vital organs and establishing a critical airway for mechanical ventilation. Once the gas exchange was fully secured, she was finally brought into the world.
Also Read : AIIMS Delhi Conducts First Successful Fetal Blood Transfusion to Save a Child With Rare Illness
Following one month of post-operative care in the intensive care and multiple follow-up post-dischargements, the infant is thriving with the doctors expecting normal long-term growth and development.
References
Society for Maternal-Fetal Medicine, Mary E. Norton, Steven P. Chauhan, and John S. Dashe. “Society for Maternal-Fetal Medicine Clinical Guideline #7: Nonimmune Hydrops Fetalis.” American Journal of Obstetrics and Gynecology 212, no. 2 (2015): 127–139. https://doi.org/10.1016/j.ajog.2014.12.018.
Dunn, Shannon B., and Julie R. Whittington. “Nonimmune Hydrops Fetalis.” NeoReviews 25, no. 8 (2024): e475–e485. https://doi.org/10.1542/neo.25-8-e475.
Stanford Medicine Children’s Health. “Hydrops Fetalis.” Stanford Medicine Children’s Health. Accessed October 5, 2026. https://www.stanfordchildrens.org/en/topic/default?id=hydrops-fetalis-90-P02374.
(Rh/APC/MSM)
