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The EXIT procedure: experience and outcome in 31 cases
Sarah Bouchard1, Mark P Johnson, Alan W Flake
1Division of Pediatric General, The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Journal of Pediatric Surgery
|March 6, 2002
Summary
The ex utero intrapartum treatment (EXIT) procedure successfully manages fetal airway obstruction and supports fetal stability during complex surgeries. This adaptable technique ensures vital gas exchange and hemodynamic balance for newborns with diverse conditions.
Area of Science:
- Perinatal medicine
- Fetal surgery
- Neonatal intensive care
Background:
- The ex utero intrapartum treatment (EXIT) procedure, initially for congenital diaphragmatic hernias (CDH), is now used for various fetal conditions.
- The EXIT procedure provides a crucial bridge for fetal intervention while maintaining placental support.
Purpose of the Study:
- To review the application and outcomes of the EXIT procedure for diverse fetal conditions.
- To evaluate fetal and maternal safety during the EXIT procedure.
Main Methods:
- Retrospective chart review of all EXIT procedures performed since 1996.
- Analysis of indications, maternal demographics, fetal outcomes, and complications.
Main Results:
- Thirty-one women underwent the EXIT procedure for indications including airway obstruction (n=13) and reversal of tracheal occlusion (n=13).
- No significant fetal hemodynamic instability occurred during uteroplacental bypass, except for one instance of reversible bradycardia.
- One fetal death occurred due to airway obstruction from a lymphangioma; two maternal complications were noted.
Conclusions:
- The EXIT procedure is a successful method for maintaining fetal gas exchange and hemodynamic stability.
- It facilitates complex fetal surgeries, ensuring a safer transition to the postnatal environment.