Successful management of fetal cervical teratoma using the EXIT procedure

Abstract

Fetal cervical teratoma is a cause of polyhydramnios, premature labor, and newborn airway obstruction. Formation of a multispecialty team and use of the EXIT procedure is essential for survival of the neonate. Without a team, there is little hope for fetal survival; mortality will be 80–100%. Early diagnosis and planning are essential. Cervical teratomas can contribute to pulmonary insufficiency and chondromalacia because of a mass effect in utero and underdevelopment of the fetal lungs. J. Matern.‐Fetal Med. 1999;8:295–297. © 1999 Wiley‐Liss, Inc.

Teratomas of the neck and mediastinum in children

“…Airway obstruction due to tracheal compression or occlusion has been reported to account for 80-100% mortality in untreated cervical teratomas in the neonatal period [10]. In our series the only newborn who died did so because of unmanageable airway obstruction.…”

“…This consists in the preservation of uteroplacental circulation during elective cesarean section in order to maintain systemic oxygenation while the airway is cleared by intubation or tracheostomy [11]. EXIT procedure has been employed with success [1,10,[12][13][14][15] although some fetuses with teratoma and severe hydrops are probably inviable. Open fetal surgery or termination has been proposed for these individuals while the remaining patients may be eligible for the EXIT procedure [16].…”

Congenital Epulis

“…This led to extensive preoperative planning, including preparation to perform an EXIT procedure at the time of the scheduled cesarean delivery. 24,25 An EXIT procedure is an attempt to secure a functional fetal airway before clamping the umbilical cord. Unlike a normal cesarean delivery, the EXIT procedure maintains uteroplacental blood flow and thus continued fetal gas exchange by only partially delivering the fetus.…”

The Effects of Sevoflurane on Isolated Gravid Human Myometrium

“…This technique is used to allow the surgical and anaesthetic teams time to establish an airway in the presence of an obstructive airway lesion, diagnosed prior to delivery. During this procedure, uterine activity may have devastating consequences, including placental separation and neonatal hypoxaemia 21 . Uterine relaxation during the EXIT procedure has generally been achieved with deep isoflurane anaesthesia because its effect on uterine tone has been well-described 5,6,22,23 .…”