EXIT procedure

A medical procedure for emergency evacuation of a patient

EXIT Procedure

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.

EXIT procedure being performed

History

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

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

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

1. Anesthesia: The mother is given general anesthesia, which also anesthetizes the fetus.
2. Uterine Incision: A low transverse uterine incision is made, similar to a cesarean section.
3. Partial Delivery: The fetal head and shoulders are delivered while the rest of the body remains in the uterus to maintain placental circulation.
4. Airway Management: The surgical team secures the fetal airway through intubation or tracheostomy.
5. 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