Modified ex utero intrapartum treatment procedure in a bicornuate uterus breech presentation Pierre Robin fetus with severe micrognathia and cleft palate

Duek, Irit; Gil, Ziv; Solt, Ido

doi:10.1002/ccr3.1799

Cited by 6 publications

(11 citation statements)

References 10 publications

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“…Fetal and placental position must also be assessed prior to commencement of the procedure. Breech position may require a modified EXIT as performed by Duek et al 4 , or external cephalic version and anterior placental position may require an upper segment uterine incision 14 .…”

Section: The Proceduresmentioning

confidence: 99%

“…Several authors described the use of an amniotic infusion with either warm Ringer's solution 8,15 or normal saline 13 to achieve this. Preservation of amniotic fluid is also maintained through partial delivery of the fetus 4 . The head, one arm and upper body of the fetus only is delivered, with the lower body and umbilical cord remaining in the uterus to preserve heat and amniotic fluid 4 .…”

Section: The Proceduresmentioning

confidence: 99%

“…Preservation of amniotic fluid is also maintained through partial delivery of the fetus 4 . The head, one arm and upper body of the fetus only is delivered, with the lower body and umbilical cord remaining in the uterus to preserve heat and amniotic fluid 4 . Fetal monitoring may occur with echocardiography 11 , pulse oximetry 13,15 or ultrasound heart rate monitoring 8 .…”

Section: The Proceduresmentioning

confidence: 99%

“…Resection of the mass and separation of conjoined twins may also occur during EXIT procedure; however, these are rare 3 . Duek et al 4 explain EXIT procedure has the ability to turn a potentially catastrophic situation into a controlled elective scenario.…”

Section: Introductionmentioning

confidence: 99%

“…Success of the procedure is dependent on accurate diagnosis prior to the procedure, a multidisciplinary approach, and appropriate facilities to carry out the procedure 4 .…”

Section: Introductionmentioning

confidence: 99%

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Ex utero intrapartum treatment (EXIT) procedure: Indications and procedural considerations

Silva¹

2019

Journal of Perioperative Nursing

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Problem identificationEx Utero Intrapartum Treatment (EXIT) has become the optimal delivery strategy in fetuses with airway compromise; however, it remains an extremely rare procedure. This review aims to provide perioperative nurses with an overview of EXIT procedure to enable them to be an effective member of the multidisciplinary team. Literature searchAn electronic search of the CINAHL, Medline and Scopus databases was undertaken yielding 19 articles for inclusion in this integrative review. The papers included were case studies, case series or retrospectives and describe 42 EXIT procedures with 43 babies. Data evaluation synthesisThe most common indication for the EXIT procedure is neck tumours, with other indications being congenital high airway obstruction syndrome (CHAOS), cardiac anomalies, extremely low birth weight (ELBW), micrognathia and congenital diaphragmatic hernia. Literature revealed 41 cases had successful establishment of an airway, with the procedure failing in two cases, both with diagnoses of CHAOS. Implications for perioperative nursing practice or researchThe role of the perioperative nurse within these cases needs to be explored further. Perioperative nurses need to have the skills and ability to participate as key members of the multidisciplinary team. This can be achieved through in-depth understanding of the topics within this review.

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Section: The Proceduresmentioning

confidence: 99%

Section: The Proceduresmentioning

confidence: 99%

Section: The Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Success of the procedure is dependent on accurate diagnosis prior to the procedure, a multidisciplinary approach, and appropriate facilities to carry out the procedure 4 .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Ex utero intrapartum treatment (EXIT) procedure: Indications and procedural considerations

Silva¹

2019

Journal of Perioperative Nursing

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Changing indications and antenatal prognostic factors for ex‐utero intrapartum treatment procedures

Porter

Trivedi

Márquez³

et al. 2022

Prenatal Diagnosis

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Objective: In cases of suspected neonatal airway obstruction, the ex-utero intrapartum treatment (EXIT) procedure is used to secure the airway while a fetus remains on placental circulation. We report indications and outcomes from all EXIT procedures at a tertiary obstetric unit between 1997 and 2020.Method: Retrospective cohort study with data collected from maternal and neonatal medical records.Results: Indications for EXIT procedures were micrognathia (n = 7), lymphatic malformations (n = 5), cervical teratomas (n = 4), goiters (n = 2), and intra-oral epulis (n = 1). Infants with a fetal teratoma were delivered earliest due to 75% presenting with preterm premature rupture of membranes or preterm labor. Low birth weight was found in 75% of these neonates; they did not survive 1 year.Intubation at EXIT occurred for 58% (n = 11) of babies, and six neonates required a tracheostomy. In four cases of fetal micrognathia, the inferior facial angle (IFA) was noted to be <5th centile. All but one micrognathia case had polyhydramnios. Of the total cohort, 75% of neonates were alive at 1 year. Conclusion:Risks for neonatal demise with EXIT include fetal teratoma, low birth weight, and prematurity. Micrognathia has become an increasingly valid indication for the procedure. The combination of polyhydramnios and IFA <5% correlates well with severe airway obstruction and suggests consideration of EXIT. Key points What's already known about this topic?� Ex-utero Intrapartum Treatment (EXIT) remains a potentially life-saving procedure for fetuses with airway obstruction. Indications for EXIT have broadened over the past 20 years. What does the study add?� Fetal teratoma, low birth weight, and prematurity should inform prenatal counseling as predictors for fetal and neonatal mortality.� To improve multidisciplinary management, all neonates with suspected fetal airway obstruction should have ultrasound and MRI imaging.� Micrognathia is now a common indication for EXIT. In cases of micrognathia, inferior facial angle (IFA) <5% in conjunction with polyhydramnios appears predictive of a difficult airway.

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Fetal markers for the detection of infants with craniofacial malformation

Wiechers

Kagan²

2021

Seminars in Fetal and Neonatal Medicine

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Modified ex utero intrapartum treatment procedure in a bicornuate uterus breech presentation Pierre Robin fetus with severe micrognathia and cleft palate

Cited by 6 publications

References 10 publications

Ex utero intrapartum treatment (EXIT) procedure: Indications and procedural considerations

Ex utero intrapartum treatment (EXIT) procedure: Indications and procedural considerations

Changing indications and antenatal prognostic factors for ex‐utero intrapartum treatment procedures

Fetal markers for the detection of infants with craniofacial malformation

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