Ex utero intrapartum treatment (EXIT procedure)
A fetus develops in the mother’s placenta, a protective sac that passes oxygen and nutrients from the mother to the fetus. The baby does not use his or her own lungs before birth for this reason. When the baby is born under normal circumstances, the placenta detaches after birth and the child’s lungs begin functioning after that. Although occurrences are rare, certain fetal anomalies can block or compress an unborn baby’s airway. Once the child is born and the placenta detaches, the ability for the baby to breathe is hindered. In these instances, an ex utero intrapartum treatment, or EXIT procedure, may be performed to deliver the baby and establish a functioning airway before the placenta detaches.
What Conditions Can Be Treated With the EXIT Procedure?
Ex utero intrapartum treatment is used when a baby’s airway is compressed or blocked by:
- Cervical teratomas (neck tumors)
- Cystic hygromas (a sac-like structure in the neck)
- Congenital high airway obstruction (CHAOS) syndrome
- Large lung lesions
EXIT Procedure Details
An ex utero intrapartum treatment procedure is similar to a Cesarean section (C-section) but has some key differences. In general, the procedure involves these steps:
- The mother undergoes general anesthesia.
- The uterus is opened using a special stapling device to help prevent bleeding.
- The baby is delivered partially through the uterine opening with the placenta remaining intact. This ensures the continued exchange of oxygen and nutrients from the mother to baby.
- The surgical team establishes an airway by clearing any obstructions and/or placing a breathing tube. This will permit the child to breathe once he or she is delivered and the placenta detaches.
- Once the baby is stable, the umbilical cord is cut and the baby is removed entirely from the uterus.
In some instances, additional procedures may be necessary to treat or remove any remaining blockages in the child’s airway.
What to Expect With the EXIT Procedure
Because the procedure is similar to a C-section—which is a frequently performed procedure with generally good outcomes—the potential risks for an ex utero intrapartum treatment are relatively low. Risks can include uterine bleeding, but this can be minimized with close coordination between the surgeon and anesthesiologist and appropriate technique with the uterine stapling device.
Effectiveness of the EXIT Procedure
Ex utero intrapartum treatments are highly effective procedures that ensure that a child can breathe whether on its own or with a breathing tube once fully delivered from the uterus.
The highly skilled neonatologists, pediatric surgeons, maternal-fetal specialists, anesthesiologists, OB-GYNs and other experts at Tampa General Hospital work together to ensure a good outcome for both mother and baby when an EXIT procedure is performed.