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Background/Purpose: The ex-utero intrapartum treatment (EXIT) procedure is used to secure effective gas exchange prior to postnatal life. We describe the obstetrical course and maternal outcomes of a series of patients who underwent EXIT.Methods: This is a review of all pregnancies in which fetuses were delivered by EXIT from January 2001 to April 2018. Outcome variables included estimated gestational age (EGA) at delivery, need for emergency EXIT, maternal estimated blood loss (EBL), need for maternal blood transfusion, and maternal postoperative length of hospital stay. Data were tested for normality and reported as median [range] and n (%). Results: A total of 45 patients were delivered by EXIT procedure. Sixteen (35.6%) of the EXIT procedures were performed emergently. Median maternal EBL was 800 (500-2000) mL; 6 (13.3%) patients received blood transfusion. Median maternal postoperative length of hospital stay was four [3-7] days. Conclusion: Our data highlight the complexity of the obstetrical management in the EXIT procedure as evidenced by an approximately 36% chance of emergency delivery. Despite having an experienced multidisciplinary team, 13.3% of our subjects underwent maternal blood transfusion. This information can be used in counseling EXIT candidates regarding the risks and benefits of this procedure.Parity, median [range] 1 [0-5] EGA at diagnosis of condition, weeks, median [range] 21 [16-36] EGA at presentation, weeks, median [range] 28 [20-37] EGA at diagnosis of polyhydramnios, weeks, median [range] 27 [18-36] EGA at delivery, median [range] 36 [28-39] Twin pregnancy, n (%) 0 (0) Male fetus, n (%) 24 (53.3) Polyhydramnios, n (%) 34 (75.6) Amnioreduction, n (%) 17 (37.8) Emergent EXIT, n (%) 16 (35.6) Preterm contractions, n (%) 12 (26.6) PPROM, n (%) 7 (15.6) Anterior placenta, n (%) 16 (35.6) Maternal estimated blood loss, mL, median [range] 800 [500-2000] Maternal blood transfusion, n (%) 6 (13.3) Duration of EXIT, min, median [range] 46 [15-133] Anesthesia duration, min, median [range] 130 [95-216] Maternal post-op length of hospital stay, days, median [range] 4 [3-7] Maternal surgical site infection, n (%) 2 (4.4)Note. Duration of EXIT was calculated as the time between skin incision and delivery of the baby.Values are presented as median [range] and n (%).Abbreviations: EGA, estimated gestational age; EXIT, ex-utero intrapartum treatment; PPROM, preterm-premature rupture of membranes.

BackgroundMycoplasma genitalium is a sexually transmitted infection (STI) pathogen. There have been no published studies concerning symptomatology, prevalence data, antibiotic resistance profiling or reports of co-infection with other STI in pregnant women.ObjectiveTo describe these characteristics among pregnant women attending prenatal clinics in a large tertiary care centre.DesignRemnant genital samples collected from pregnant women between August 2018 and November 2019 were tested for M. genitalium and Trichomonas vaginalis by the transcription-mediated amplification technique. Specimens with detectable M. genitalium RNA were sequenced for 23S rRNA mutations associated with azithromycin resistance and parC and gyrA mutations associated with resistance to moxifloxacin. Demographic, obstetric and STI co-infection data were recorded.ResultsOf the 719 samples, 41 (5.7 %) were positive for M. genitalium. M. genitalium infection was associated with black race, Hispanic ethnicity and young age (p=0.003, p=0.008 and p=0.004, respectively). M. genitalium infection was also associated with T. vaginalis co-infection and Streptococcus agalactiae (group B Streptococcus) colonisation (p≤0.001 and p=0.002, respectively). Of the 41 positive samples, 26 (63.4%) underwent successful sequencing. Eight (30.8%) had 23S rRNA mutations related to azithromycin resistance. One of 26 (3.8%) positive samples with sequencing results had the gyrA gene mutation and 1 of 18 sequenced samples (5.6%) had the parC gene mutation associated with moxifloxacin resistance.ConclusionsPrevalence rates of M. genitalium in pregnant women was 5.7%. M. genitalium infection disproportionately affects young black women co-infected with T. vaginalis. Pregnant women remain at risk for persistent infection with M. genitalium due to decreased azithromycin susceptibility.