The ex-utero intrapartum treatment

Advances in prenatal diagnosis, combined with a better understanding of the natural history of prenatally diagnosed anomalies, are providing increasing opportunities to consider fetal intervention in selected cases of life-threatening malformations. Accurate prenatal diagnosis can now accurately identify fetal pathophysiology that poses an immediate threat to the life of the newborn infant on separation from the placental circulation. In this circumstance, the ex-utero intrapartum treatment (EXIT) procedure, which maintains intrapartum uteroplacental support, can be life saving. The most common indications for the EXIT procedure are fetal lesions causing extrinsic or intrinsic airway obstruction. However, fetuses with other anomalies that may compromise neonatal resuscitation can also benefit from this approach. The EXIT procedure differs significantly from a cesarean delivery, and caution must be taken to avoid maternal morbidity. As with all endeavors involving maternal-fetal intervention, a team approach is crucial to ensure accurate diagnosis and optimal perinatal management.