EXIT procedure: Difference between revisions

Latest revision as of 03:55, 13 February 2025

A medical procedure for emergency evacuation of a patient

EXIT Procedure[edit]

The Ex Utero Intrapartum Treatment (EXIT) procedure is a specialized surgical technique used to deliver and treat a fetus with airway obstruction while maintaining uteroplacental circulation. This procedure is primarily performed when prenatal imaging indicates that the fetus has a condition that could compromise the airway at birth, such as a large cervical teratoma, congenital high airway obstruction syndrome (CHAOS), or severe laryngeal atresia.

History[edit]

The EXIT procedure was developed from the ex utero intrapartum therapy techniques used in fetal surgery. Initially, it was used to reverse tracheal occlusion in fetuses with congenital diaphragmatic hernia. Over time, its application has expanded to include a variety of fetal conditions that require immediate postnatal intervention.

Indications[edit]

The primary indication for the EXIT procedure is the presence of a fetal airway obstruction that could lead to immediate respiratory distress upon delivery. Conditions that may necessitate an EXIT procedure include:

Congenital cystic adenomatoid malformation (CCAM)
Cervical teratoma
Laryngeal atresia
Congenital high airway obstruction syndrome (CHAOS)

Procedure[edit]

The EXIT procedure is performed in an operating room equipped for both fetal and maternal surgery. The steps involved include:

Anesthesia: The mother is given general anesthesia, which also anesthetizes the fetus.
Uterine Incision: A low transverse uterine incision is made, similar to a cesarean section.
Partial Delivery: The fetal head and shoulders are delivered while the rest of the body remains in the uterus to maintain placental circulation.
Airway Management: The surgical team secures the fetal airway through intubation or tracheostomy.
Delivery Completion: Once the airway is secured, the rest of the fetus is delivered.

Advantages[edit]

The EXIT procedure allows for controlled management of the fetal airway while ensuring oxygenation through the placenta. This reduces the risk of hypoxia and other complications associated with airway obstruction at birth.

Risks and Complications[edit]

While the EXIT procedure can be life-saving, it carries risks such as:

Maternal hemorrhage
Uterine atony
Preterm labor
Fetal distress

Postoperative Care[edit]

After the EXIT procedure, both the mother and the newborn require close monitoring. The newborn may need additional surgeries or interventions depending on the underlying condition.

Related Pages[edit]

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-'''EXIT procedure''' (Ex Utero Intrapartum Treatment) is a highly specialized surgical operation used to deliver babies who have conditions that block their airway or require immediate medical intervention before the umbilical cord is cut. This procedure is performed while the baby is still connected to the placenta and receiving oxygenated blood, which allows for a more stable transition to postnatal life.
+{{Short description|A medical procedure for emergency evacuation of a patient}}
-==Indications==
+== EXIT Procedure ==
-The EXIT procedure is indicated for fetuses with conditions that compromise the airway or require immediate postnatal intervention to ensure survival. These conditions include, but are not limited to, [[Congenital Diaphragmatic Hernia (CDH)]], [[Cystic Hygroma]], [[Laryngeal Atresia]], and large [[Neck Masses]] such as [[Teratoma]] or [[Lymphangioma]]. It is also used in cases of [[Fetal Surgery]] where the fetus needs to be partially delivered to treat a condition before complete delivery.
+The [[Ex Utero Intrapartum Treatment]] (EXIT) procedure is a specialized surgical technique used to deliver and treat a fetus with airway obstruction while maintaining uteroplacental circulation. This procedure is primarily performed when prenatal imaging indicates that the fetus has a condition that could compromise the airway at birth, such as a large [[cervical teratoma]], [[congenital high airway obstruction syndrome]] (CHAOS), or severe [[laryngeal atresia]].
-==Procedure==
+[[File:EXIT.jpg|thumb|right|EXIT procedure being performed]]
-The EXIT procedure is performed under general anesthesia for the mother in an operating room equipped for both cesarean delivery and neonatal surgery. The mother's uterus is exposed via a cesarean section, and the fetus is partially delivered, keeping the placenta and umbilical cord intact. This maintains placental circulation, providing oxygen to the fetus while allowing the surgical team to secure the airway or perform necessary interventions. Once the airway is secured or the intervention is completed, the baby is fully delivered, and the umbilical cord is cut.
-==Risks and Complications==
+=== History ===
-As with any surgical procedure, the EXIT procedure carries risks for both the mother and the fetus. These include bleeding, infection, and the potential need for a hysterectomy due to uterine atony or injury. For the fetus, risks include hypoxia, acidosis, and injury during the procedure. However, with careful planning and a skilled multidisciplinary team, these risks can be minimized.
+The EXIT procedure was developed from the [[ex utero intrapartum therapy]] techniques used in fetal surgery. Initially, it was used to reverse tracheal occlusion in fetuses with congenital diaphragmatic hernia. Over time, its application has expanded to include a variety of fetal conditions that require immediate postnatal intervention.
-==Outcomes==
+=== Indications ===
-The success of the EXIT procedure largely depends on the underlying condition being treated and the presence of any additional anomalies. In many cases, the EXIT procedure has enabled successful intervention for conditions that would otherwise be fatal at birth, providing a bridge to postnatal life and further treatment.
+The primary indication for the EXIT procedure is the presence of a fetal airway obstruction that could lead to immediate respiratory distress upon delivery. Conditions that may necessitate an EXIT procedure include:
+* [[Congenital cystic adenomatoid malformation]] (CCAM)
+* [[Cervical teratoma]]
+* [[Laryngeal atresia]]
+* [[Congenital high airway obstruction syndrome]] (CHAOS)
-==Multidisciplinary Approach==
+=== Procedure ===
-The EXIT procedure requires a coordinated effort from a multidisciplinary team including maternal-fetal medicine specialists, neonatologists, pediatric surgeons, anesthesiologists, and nursing staff. This team approach ensures comprehensive care for both the mother and the fetus during the procedure.
+The EXIT procedure is performed in an operating room equipped for both fetal and maternal surgery. The steps involved include:
+# '''Anesthesia''': The mother is given general anesthesia, which also anesthetizes the fetus.
+# '''Uterine Incision''': A low transverse uterine incision is made, similar to a [[cesarean section]].
+# '''Partial Delivery''': The fetal head and shoulders are delivered while the rest of the body remains in the uterus to maintain placental circulation.
+# '''Airway Management''': The surgical team secures the fetal airway through intubation or tracheostomy.
+# '''Delivery Completion''': Once the airway is secured, the rest of the fetus is delivered.
+=== Advantages ===
+The EXIT procedure allows for controlled management of the fetal airway while ensuring oxygenation through the placenta. This reduces the risk of hypoxia and other complications associated with airway obstruction at birth.
+=== Risks and Complications ===
+While the EXIT procedure can be life-saving, it carries risks such as:
+* Maternal hemorrhage
+* Uterine atony
+* Preterm labor
+* Fetal distress
+=== Postoperative Care ===
+After the EXIT procedure, both the mother and the newborn require close monitoring. The newborn may need additional surgeries or interventions depending on the underlying condition.
+== Related Pages ==
+* [[Fetal surgery]]
+* [[Congenital diaphragmatic hernia]]
+* [[Neonatal resuscitation]]
 [[Category:Medical procedures]]
-[[Category:Pediatrics]]
+[[Category:Obstetrics]]
-[[Category:Neonatology]]
+[[Category:Pediatric surgery]]
-{{Medicine-stub}}