EXIT procedure

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.

Indications

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.

Procedure

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

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.

Outcomes

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.

Multidisciplinary Approach

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.