EXIT (ex utero intrapartum treatment) surgery for the management of fetal airway obstruction: A systematic review of the literature

Novoa, Rommy H.; Quintana, Willy; Castillo‐Urquiaga, Walter; Ventura, Walter

doi:10.1016/j.jpedsurg.2020.02.011

Cited by 31 publications

(30 citation statements)

References 102 publications

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“…Novoa et al [21] recently published a systematic review of the literature evaluating the results of the EXIT surgery in neonatal management of fetal upper airway obstruction. The authors report a fetal or neonatal death rate of 17% (40/235), with an overall fetal adverse event rate of 29.2%.…”

Section: Discussionmentioning

confidence: 99%

Ex-Utero Intrapartum Treatment (EXIT): indications and outcome in fetal cervical and oropharyngeal masses

García‐Díaz

Chimenea

Agustín

et al. 2020

BMC Pregnancy Childbirth

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Background The “Ex-Utero Intrapartum Treatment” (EXIT) procedure allows to ensure fetal airway before completion of delivery and umbilical cord clamping while keeping uteroplacental circulation. Airway obstruction in fetal oropharyngeal and cervical masses can be life-threatening at birth. In those situations, controlled access to fetal airway performed by a trained multidisciplinary team allows safe airway management, while feto-maternal circulation is preserved. We aim to review the indications and outcome of the EXIT procedure in a case series of fetal cervical and oropharyngeal masses. Methods We have carried out a retrospective review of all patients with fetal cervical and oropharyngeal masses who underwent an EXIT procedure between 2008 and 2019. Variables evaluated included indication for EXIT, ultrasound and MRI findings, the need of amnioreduction, gestational age at EXIT, birth weight, complications, operative time, survival rate, pathological findings, and postnatal evolution. Five patients are included in this series. One additional case has already been published. Results The diagnosis were cervical teratoma (n = 1), epulis (n = 1) and lymphangioma (n = 3). Polyhydramnios was present in 2 patients, requiring amnioreduction in one of them. Mean gestational age at EXIT was 36–37 weeks (range, 34–38 weeks). Median EXIT time in placental support was 9 min (range, 3–22 min). Access to airway was successfully established in EXIT in all cases. All children born by EXIT are currently healthy and without complications. Conclusion The localization and characteristics of the mass, its relationship to the airway, and the presence of polyhydramnios seem to be major factors determining indications for EXIT and clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Ex-Utero Intrapartum Treatment (EXIT): indications and outcome in fetal cervical and oropharyngeal masses

García‐Díaz

Chimenea

Agustín

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…Novoa et al [22] recently published a systematic review of the literature evaluating the results of the EXIT surgery in neonatal management of fetal upper airway obstruction. The authors report a fetal or neonatal death rate of 17% (40/235), with an overall fetal adverse event rate of 29.2%.…”

Section: Discussionmentioning

confidence: 99%

Ex-Utero Intrapartum Treatment (EXIT): indications and outcome in fetal cervical and oropharyngeal masses

García‐Díaz

Chimenea

Agustín

et al. 2020

Preprint

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Background: The “Ex-Utero Intrapartum Treatment” (EXIT) procedure allows to ensure fetal airway before completion of delivery and umbilical cord clamping while keeping uteroplacental circulation. Airway obstruction in fetal oropharyngeal and cervical masses can be life-threatening at birth. In those situations, controlled access to fetal airway performed by a trained multidisciplinary team allows safe airway management, while feto-maternal circulation is preserved. We aim to review the indications and outcome of the EXIT procedure in a case series of fetal cervical and oropharyngeal masses.Methods: We have carried out a retrospective review of all patients with fetal cervical and oropharyngeal masses who underwent an EXIT procedure between 2008 and 2019. Variables evaluated included indication for EXIT, ultrasound and MRI findings, the need of amnioreduction, gestational age at EXIT, birth weight, complications, operative time, survival rate, pathological findings, and postnatal evolution. Five patients are included in this series. One additional case has already been published.Results: The diagnosis were cervical teratoma (n=1), epulis (n=1) and lymphangioma (n=3). Polyhydramnios was present in 2 patients, requiring amnioreduction in one of them. Mean gestational age at EXIT was 36-37 weeks (range, 34-38 weeks). Median EXIT time in placental support was 9 minutes (range, 3-22 minutes). Access to airway was successfully established in EXIT in all cases. All children born by EXIT are currently healthy and without complications. Conclusion: The localization and characteristics of the mass, its relationship to the airway, and the presence of polyhydramnios seem to be major factors determining indications for EXIT and clinical outcome.

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“…One of the largest series reporting outcomes from 65 cases had an overall mortality at 5% for airway cases, which increased to 25% when a complex airway (those requiring surgical intervention) was involved and one intra‐uterine death [18]. A recent publication reviewing 235 ex‐utero intrapartum treatments for fetal airway obstruction secondary to cervical or oral tumours reported an 83% overall fetal survival rate [15]. The most frequent causes of death included: cardiorespiratory failure (nine cases); pulmonary hypoplasia (eight cases); and intubation or tracheostomy failure (six cases).…”

Section: Ex‐utero Intrapartum Treatmentmentioning

confidence: 99%

“…Most ex‐utero intrapartum treatments are planned to occur at 36–37 weeks’ gestation, to reduce the risk of pre‐term labour and emergency delivery. While a recent systematic review of ex‐utero intrapartum treatments for fetal airway obstruction secondary to cervical or oral tumours found around a quarter of cases reported in the literature were emergencies, due to the complexity of these procedures we do not advocate emergency procedures in our unit [15].…”

Section: Ex‐utero Intrapartum Treatmentmentioning

confidence: 99%

“…Hysterectomy may be required to control haemorrhage as a worst‐case scenario. Although much less common, regional anaesthesia has been used successfully used for ex‐utero intrapartum treatment procedures, around 1–5% in two recent systematic reviews [15, 17]. When regional anaesthesia is used, additional uterine relaxation is required, usually via glyceryl trinitrate infusion.…”

Section: Ex‐utero Intrapartum Treatmentmentioning

confidence: 99%

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Maternal and fetal anaesthesia for fetal surgery

2021

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Summary Over the last three decades, advances in early diagnosis of fetal anomalies, imaging and surgical techniques have led to a huge expansion in fetal surgery. A small number of specialist centres perform fetal surgery, which involves high‐risk anaesthesia for the mother and fetus. The anaesthetist plays an integral role within the large multispecialty and multidisciplinary team, involved in planning and delivering care for complex surgical procedures. This article reviews three fetal surgical procedures, congenital diaphragmatic hernia, myelomeningocele repair and ex‐utero intrapartum treatment for airway obstruction. The underlying fetal pathology, surgical management, anaesthetic considerations and risks for both the mother and fetus are described for each. Fundamental to this is the understanding that clear communication and collaboration between all team members is vital to ensure successful outcomes of patients, the mother and the fetus.

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EXIT (ex utero intrapartum treatment) surgery for the management of fetal airway obstruction: A systematic review of the literature

Cited by 31 publications

References 102 publications

Ex-Utero Intrapartum Treatment (EXIT): indications and outcome in fetal cervical and oropharyngeal masses

Ex-Utero Intrapartum Treatment (EXIT): indications and outcome in fetal cervical and oropharyngeal masses

Ex-Utero Intrapartum Treatment (EXIT): indications and outcome in fetal cervical and oropharyngeal masses

Maternal and fetal anaesthesia for fetal surgery

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