Obstetric outcomes of ex‐utero intrapartum treatment (EXIT)

Abstract

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.

Perinatal characteristics and early childhood follow up after ex‐utero intrapartum treatment for head and neck teratomas by prenatal diagnosis

“…Obstetric outcomes in this retrospective study are comparable to previous evaluations of EXIT for cervical teratomas. Length of hospital stay was similar to that reported in previous studies 14 15 There were quite some patients with polyhydramnios who required amnioreduction, and most had subsequent preterm contractions.…”

Error traps in anesthesia for fetal interventions

“…In addition, 3/65 patients had a placental abruption 26 . Finally, another single‐center study reviewed EXIT procedures and found 6/45 (13%) patients required a maternal blood transfusion 27 . The potential need for transfusion is undoubtedly higher in EXIT procedures, as additional blood loss can occur if uterine tone does not increase following delivery.…”

EXIT: Estado del arte y cómo lo hacemos

“…En una serie de 45 casos, donde 35,6% fueron de emergencia, fue reportada una pérdida hemática media de 800 mL (500-2.000), en las que un 13,3% de las pacientes recibieron transfusión. La estadía hospitalaria fue de unos 4 días (3-7) 1 .…”

“…Fetos con potencial obstrucción de vía aérea neonatal, como los diagnosticados con masas cervicales congénitas, síndrome de obstrucción de vía aérea alta congénito (CHAOS por sus siglas en inglés) y micrognatia severa requieren de manejo especializado de la vía aérea al momento del parto 1 . Estas patologías han sido asociadas históricamente con pobres resultados, donde la asfixia y muerte perinatal eran frecuentes [2][3][4][5][6][7][8] .…”