The EXIT (ex utero intrapartum treatment) procedure

Area of Science:

• Perinatology
• Pediatric Surgery
• Obstetrics

Background:

• Fetal upper airway obstruction presents a high mortality risk without immediate intervention.
• The ex utero intrapartum treatment (EXIT) procedure offers a novel solution by securing the fetal airway during surgery while maintaining uteroplacental circulation.

Observation:

• Two neonates with prenatally diagnosed upper airway obstruction were delivered successfully using the EXIT procedure.
• Case 1 involved epignathus, a rare teratoma of the nasopharynx/oropharynx.
• Case 2 involved a giant lymphangioma, a lymphatic system malformation.

Findings:

• The EXIT procedure facilitated smooth delivery and established airways for both neonates.
• Post-procedure, neonate prognoses significantly improved.
• Short-term maternal outcomes, including infection rates, blood loss, and hospital stay, were comparable to routine cesarean sections.

Implications:

• The EXIT procedure is a viable and effective intervention for complex fetal upper airway obstructions.
• This technique enhances survival rates and long-term outcomes for affected neonates.
• It demonstrates maternal safety, making it a valuable option in high-risk pregnancies.