The ex utero intrapartum treatment (EXIT) procedure in fetal neck masses: a case report and review of the literature

Stevens, G. H.; Schoot, B.C.; Smets, M.; Kremer, Bernd; Manni, J. J.; Gavilanes, Antonio W. D.; Wilmink, J. T.; Heurn, L.W.E. van; Hasaart, T. H. M.

doi:10.1016/s0301-2115(01)00467-5

Cited by 56 publications

(46 citation statements)

References 19 publications

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“…While some previous reports recommended giving 100% oxygen, 1,5,9 an inspired oxygen concentration of 50% also provided adequate fetal oxygenation. 6,11 In retrospect, it would have probably been prudent to administer 100% oxygen, especially since we were unable to reliably monitor the fetal oxygen saturation during the procedure.…”

Section: Discussionmentioning

confidence: 95%

“…The halogenated agents provide the necessary uterine relaxation for partial fetal delivery and preventing placental disruption while also providing fetal anesthesia. 5,8,9 Neuraxial anesthesia has been reported sparingly in the anesthesia literature for the EXIT procedure. 10 We present three cases where neuraxial anesthesia was used successfully for Cesarean deliveries (CD) involving EXIT procedures.…”

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confidence: 99%

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Case series: Combined spinal epidural anesthesia for Cesarean delivery andex utero intrapartum treatment procedure

George

Melnick

Rose

et al. 2007

Can J Anesth/J Can Anesth

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Purpose:To report the use of regional anesthesia and iv nitroglycerin to provide anesthesia and uterine relaxation for three Cesarean deliveries (CD) involving ex utero intrapartum treatment (EXIT) of potentially life-threatening airway obstruction in the newborn. Clinical features:Case 1 -a 36-yr-old woman at 38 weeks' gestation was scheduled for an elective CD for fetal skeletal dysplasia and micrognathia. Case 2 -a 34-yr-old woman at 35 weeks gestation had a fetal ultrasound revealing fixed neck flexion and micrognathia consistent with fetal arthrogryposis. Case 3 -a 27-yr-old woman presented at 38 weeks gestation for CD for severe fetal micrognathia, with mandibular growth below the fifth percentile. For each case, a combined spinal epidural anesthetic was performed with 0.75% bupivacaine, fentanyl and morphine intrathecally followed by placement of a multiorifice epidural catheter. Prior to uterine incision patients received a loading dose followed by an iv infusion of nitroglycerin. Uterine relaxation was sufficient in all cases for delivery of the fetus, and allowed for evaluation by direct laryngoscopy and intubation while maintaining fetal-placental circulation. The surgical procedures were completed without incident.Conclusions: Anesthesia and uterine relaxation for CD and EXIT procedures can be safely provided with regional anesthesia and iv nitroglycerin.

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Case series: Combined spinal epidural anesthesia for Cesarean delivery andex utero intrapartum treatment procedure

George

Melnick

Rose

et al. 2007

Can J Anesth/J Can Anesth

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“…The EXIT procedure was successfully used in cases in which it is possible to anticipate the difficulties related to the access to the neonate's airways 6,7,11,12 . After uterine incision, only the fetal head is delivered.…”

Section: Discussionmentioning

confidence: 99%

Anestesia para tratamento intraparto extraútero (EXIT) em fetos com diagnóstico pré-natal de malformações cervical e oral: relato de casos

Helfer¹,

Clivatti

Yamashita³

et al. 2012

Rev. Bras. Anestesiol.

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Helfer DC, Clivatti J, Yamashita AM, Moron AF -Anesthesia for Ex Utero Intrapartum Treatment (EXIT procedure) in Fetus with Prenatal Diagnosis of Oral and Cervical Malformations: Case Reports. Background and objectives:Fetus prenatally diagnosed with neck tumors, or with any other disease that obstructs the airways, should not be treated conventionally, as the assistant physician has to face two challenges right after the infant's delivery: the limited time to establish the access to the potentially difficult airways and the lack of anesthesia of the neonate in case of instrumentation of the airways. The ex utero intrapartum treatment, i.e., the EXIT procedure consists of maintaining the fetoplacental circulation during the cesarean section, until the airways of the fetus be secured.

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“…Ultrasonography and MRI are adequate in most cases for determining the size, location, and type of neck mass as well as the relationship between the fetal neck mass and essential structures like trachea and esophagus. Neck teratomas, cystic hygromas, hemangiomas, and congenital goiters can be differentiated prenatally on ultrasound and MRI [2][3][4] . Cystic hygromas present on ultrasound as cystic structures, most hemangiomas have a rich blood supply, and congenital goiters present as symmetrical and solid lobular tumors.…”

Section: Discussionmentioning

confidence: 99%

The ex utero Intrapartum Treatment (EXIT) Procedure in Giant Fetal Neck Masses

Ogamo¹,

Sugiyama²,

Maeda³

et al. 2005

Fetal Diagn Ther

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Giant fetal neck masses can cause airway obstructions with potential poor fetal prognosis after delivery. The relationship between the fetal neck mass and airway structure can be defined prenatally with ultrasound and magnetic resonance imaging (MRI). The ex utero intrapartum treatment (EXIT) procedure is an available technique to obtain a fetal airway while feto-maternal circulation is preserved. We present a case in which prenatally a giant fetal neck mass was diagnosed on ultrasound and MRI, and a successful EXIT procedure could be performed.

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The ex utero intrapartum treatment (EXIT) procedure in fetal neck masses: a case report and review of the literature

Cited by 56 publications

References 19 publications

Case series: Combined spinal epidural anesthesia for Cesarean delivery andex utero intrapartum treatment procedure

Case series: Combined spinal epidural anesthesia for Cesarean delivery andex utero intrapartum treatment procedure

Anestesia para tratamento intraparto extraútero (EXIT) em fetos com diagnóstico pré-natal de malformações cervical e oral: relato de casos

The ex utero Intrapartum Treatment (EXIT) Procedure in Giant Fetal Neck Masses

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