EXIT (ex utero Intrapartum Treatment) to Airway Procedure for Twin Fetuses With Oropharyngeal Teratomas: Lessons Learned

King, Alice; Keswani, Sundeep G.; Belfort, Michael A.; Nassr, Ahmed A.; Espinoza, Jimmy; Bedwell, Joshua R.; Mehta, Deepak; Doughty, Cara; Leong-Kee, Susan; Lawrence, Julia; Sun, Raphael C.; Lee, Timothy C.

doi:10.3389/fsurg.2020.598121

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…The rationale behind this nuanced approach is deeply rooted in the well-documented escalation of intrauterine pressure following childbirth, reaching levels significantly higher than systolic blood pressure [41]. The consequence of this heightened pressure is an abrupt decrease in maternal placental perfusion, despite the persistence of umbilical pulsations for a brief duration post-delivery [1].…”

Section: Discussionmentioning

confidence: 99%

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

Domínguez-Moreno,

Chimenea,

Viegas-González

et al. 2024

Surgical Techniques Development

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The Ex Utero Intrapartum Treatment (EXIT) procedure has long been an invaluable tool in managing complex fetal conditions requiring airway interventions during the transition from intrauterine to extrauterine life. This technical note offers an in-depth examination of the EXIT procedure, emphasizing the refinements and innovations introduced at our center. The technique focuses on meticulous preoperative assessment and uses distinctive techniques and anesthetic methodologies. A multidisciplinary team assembles to plan the EXIT procedure, emphasizing patient communication and risk discussion. Our technique involves atraumatic access to the uterine cavity, achieved through the application of a uterine progressive distractor developed for this purpose. Following the use of this distractor, vascular clamps and a stapling device (Premium Poly Cs-57 Autosuture®, Medtronic) are employed. Our anesthetic approach employs general anesthesia with epidural catheter placement. Maternal operation involves low transverse laparotomy and intraoperative ultrasonography-guided hysterotomy. Fetal exposure includes gentle extraction or external version, ensuring airway access. After securing fetal airway access, umbilical cord clamping and maternal abdominal closure conclude the procedure. By revisiting the core principles of EXIT and incorporating center-specific advancements, we enhance our understanding and technical expertise. To our knowledge, this is the first time a detailed description of the technique has been published.

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Section: Discussionmentioning

confidence: 99%

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

Domínguez-Moreno,

Chimenea,

Viegas-González

et al. 2024

Surgical Techniques Development

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show abstract

“…The primary goal is to provide a safe airway in the neck, face and mediastinum pathologies that cause full obstruction in the early postnatal period by damaging or compressing the airway structures. The use of the EXIT procedure to facilitate airway safety in a controlled manner while placental circulation continues, has been proposed as an optimal administration strategy for patients with such pathologies (9)(10)(11)(12)(13)(14)(15) . With EXIT procedure, the reported survival becomes 50% for tracheal atresia and 94% for laryngeal atresia.…”

Section: Discussionmentioning

confidence: 99%

Prenatal Tanılı Servikal Kitleye Ekstrauterin İntrapartum Tedavi ((EXIT) Yöntemiyle Yaklaşım

Özcan¹,

Karagöz²,

Hakalmaz³

et al. 2022

JTAPS

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A patient with prenatal diagnosis of a cervical mass compressing the trachea managed by the the exutero intrapartum treatment (EXIT) at birth was detailed. The patient had presented with polyhydramnios and a cervical mass during the prenatal period. At the thirty-seventh gestational week, decision was given to perform the delivery with the EXIT procedure. The baby was delivered by cesarean section under general anesthesia, with the entire team ready to be sterile intraoperatively. The baby was intubated oropharyngeally without clamping the cord to preserve uteroplacental and placento-fetal circulation. The cord was then clamped and the patient taken to the neonatal intensive care unit under stable condition. On the 2nd postnatal day, cervical CT showed a 65x65x55 mm solid mass lesion, which was totally excised on the 3rd postnatal day.Histopathological examination revealed an immature teratoma. The patient is well and without any clinical problem in the 3th postoperative year of follow-up. The EXIT procedure is an effective treatment option in cervical masses that cause severe airway obstruction during the prenatal period, as it preserves placentofetal circulation until safe airway is achieved. Multidisciplinary approach and planning is required for safe performance of this advanced perinatal resuscitation technique.

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“…Very few cases of Ex-Utero-Intrapartum-Treatment (EXIT) procedures for twin pregnancy have been reported 6,[9][10][11][12] . Here, we report a singular methodology for EXIT-to-airway procedures in both monochorionic and dichorionic twin pregnancies.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Ex-Utero Intrapartum Treatment-to-Airway for Obstructing Fetal Neck Masses: A Singular Methodology for Monochorionic and Dichorionic Twin Pregnancies

Papastefan,

Scorletti,

Alhajjat

et al. 2023

AJP Rep

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INTRODUCTION: Fetal airway obstruction in one twin of a diamniotic pregnancy presents unique challenges. Very few cases of Ex-Utero-Intrapartum-Treatment (EXIT) procedures for twin pregnancy have been reported and only in dichorionic pregnancies. We report a singular methodology for EXIT-to-airway procedures in two pregnancies involving monochorionic and dichorionic twins. CASE PRESENTATION: Two cases of EXIT-to-airway in twin pregnancies were performed in 2018-2019 at a regional fetal treatment center. Case 1 involved a giant cervical teratoma in a monochorionic-diamniotic twin pregnancy with preterm labor at 29 weeks. Case 2 involved a dichorionic-diamniotic pregnancy with a large cervical lymphatic malformation with preterm labor at 36 weeks. In each case, the polyhydramnios caused the affected twin’s amniotic sac to be the presenting sac for the surgical approach. Bronchoscopy and successful intubation was completed after 22 and 10 minutes of uteroplacental bypass, respectively. The bystander twins were delivered second without intubation and resuscitated without perinatal distress. CONCLUSION: EXIT-to-airway appears to be a reasonable option for twins including monochorionic pregnancies, via delivery of the affected twin first followed by delivery of the bystander twin. Thoughtful preparation and counseling by an experienced multidisciplinary team permits an EXIT-to-airway approach for twin pregnancies even in an emergent setting.

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EXIT (ex utero Intrapartum Treatment) to Airway Procedure for Twin Fetuses With Oropharyngeal Teratomas: Lessons Learned

Cited by 7 publications

References 8 publications

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

Prenatal Tanılı Servikal Kitleye Ekstrauterin İntrapartum Tedavi ((EXIT) Yöntemiyle Yaklaşım

Ex-Utero Intrapartum Treatment-to-Airway for Obstructing Fetal Neck Masses: A Singular Methodology for Monochorionic and Dichorionic Twin Pregnancies

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