The EXIT procedure: Experience and outcome in 31 cases

Theex utero intrapartum treatment (EXIT) procedure: maternal and fetal considerations

“…In a series of 31 patients, the average estimated blood loss was about 850 mL. 10 There were only two maternal complications reported in this series -one patient had a severe hemorrhage and a second patient suffered a uterine dehiscence with a subsequent pregnancy. Other investigators compared the incidence of maternal complications in 34 patients who had the EXIT procedure compared to 32 matched controls who had a Cesarean delivery without an EXIT procedure.…”

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

“…In a recently published paper, Kornacki et al10 reported their experience with three successful EXIT procedures performed in fetuses with neck tumors (thyroid goiter, neck lymphangioma, and giant neck teratoma). Early evaluation and planning by a multidisciplinary team, based upon thorough assessment of the fetal anatomy with fetal two‐ and three‐dimensional US, echocardiography, and MRI, are essential to correctly qualify the fetus for the EXIT procedure 2, 3, 5, 7, 8, 9, 10. As opposed to the cesarean section deliveries where uterine contraction is desired to reduce maternal blood loss, during the EXIT procedure the achievement of tocolysis and uterine hypotonia are essential to preserve uteroplacental circulation and prevent placental separation,2 increasing the risk of massive maternal blood loss.…”

“…Once adequate airway and ventilation are secured, the fetus can be safely taken off placental support 2. The indications for EXIT procedure include various conditions associated with possible fetal airway obstruction (Table 1, 2, 3, 4, 5, 6). The successful outcome of an EXIT procedure rests upon thorough and accurate prenatal investigation, appropriate presurgical planning, and the availability of a highly skilled multidisciplinary team and facilities.…”

Obstetric hemorrhage during an exit procedure for severe fetal airway obstruction

“…9 Significant maternal blood loss ([2000 mL) has been previously described in several cases undergoing EXIT procedures, with no significant intraoperative adverse sequelae reported. 1,5,10 However, management strategies for dealing with severe unexpected obstetric hemorrhage during EXIT procedures are not well described.…”

“…1 Fetal oxygenation is preserved by the utero-placental circulation, which can offer sufficient time to achieve surgical access to the fetal airway by intubation, tracheostomy, or resection. The maintenance of uterine relaxation (by inhalational anesthesia and/or tocolysis) and surgical hemostasis are critical to the success of the procedure.…”