EXIT procedure

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The EXIT procedure, or ex utero intrapartum treatment procedure, is a specialized surgical delivery procedure used to deliver babies who have airway compression[1] due to bronchopulmonary sequestration, congenital cystic adenomatoid malformation, cervical teratoma, or other congenital disorder.

Process

The EXIT is an extension of a standard classical Caesarean section, where an opening is made on the midline of the anesthetized mother's abdomen and uterus. Then comes the EXIT: the baby is partially delivered through the opening but remains attached by its umbilical cord to the placenta, while a pediatric or neonatal general surgeon establishes an airway so the fetus can breathe. Once the EXIT is complete, the umbilical cord is cut and clamped, and the infant is fully delivered. Then the remainder of the C-section proceeds.

Challenges

The EXIT is much more complex than a standard C-section, as it requires careful coordination between the mother's physicians and the specialists operating on the newborn baby. The difficulty lies in preserving enough blood flow through the umbilical cord, protecting the placenta, and avoiding contractions of the uterus so that there is sufficient time to establish the airway.

References

  1. Hirose S, Farmer DL, Lee H, Nobuhara KK, Harrison MR (2004). "The ex utero intrapartum treatment procedure: Looking back at the EXIT". J. Pediatr. Surg. 39 (3): 375–80; discussion 375–80. PMID 15017555. 
  • Bouchard S, Johnson MP, Flake AW; et al. (2002). "The EXIT procedure: experience and outcome in 31 cases". J. Pediatr. Surg. 37 (3): 418–26. PMID 11877660. 

See also

it:EXIT


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