Ex-Utero Intrapartum Treatment (EXIT): indications and outcome in fetal cervical and oropharyngeal masses
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(2020) 20:598
RESEARCH ARTICLE
Open Access
Ex-Utero Intrapartum Treatment (EXIT): indications and outcome in fetal cervical and oropharyngeal masses Lutgardo García-Díaz1, Angel Chimenea1,2, Juan Carlos de Agustín3, Antonio Pavón4 and Guillermo Antiñolo1,2,5*
Abstract Background: The “Ex-Utero Intrapartum Treatment” (EXIT) procedure allows to ensure fetal airway before completion of delivery and umbilical cord clamping while keeping uteroplacental circulation. Airway obstruction in fetal oropharyngeal and cervical masses can be life-threatening at birth. In those situations, controlled access to fetal airway performed by a trained multidisciplinary team allows safe airway management, while feto-maternal circulation is preserved. We aim to review the indications and outcome of the EXIT procedure in a case series of fetal cervical and oropharyngeal masses. Methods: We have carried out a retrospective review of all patients with fetal cervical and oropharyngeal masses who underwent an EXIT procedure between 2008 and 2019. Variables evaluated included indication for EXIT, ultrasound and MRI findings, the need of amnioreduction, gestational age at EXIT, birth weight, complications, operative time, survival rate, pathological findings, and postnatal evolution. Five patients are included in this series. One additional case has already been published. Results: The diagnosis were cervical teratoma (n = 1), epulis (n = 1) and lymphangioma (n = 3). Polyhydramnios was present in 2 patients, requiring amnioreduction in one of them. Mean gestational age at EXIT was 36–37 weeks (range, 34–38 weeks). Median EXIT time in placental support was 9 min (range, 3–22 min). Access to airway was successfully established in EXIT in all cases. All children born by EXIT are currently healthy and without complications. Conclusion: The localization and characteristics of the mass, its relationship to the airway, and the presence of polyhydramnios seem to be major factors determining indications for EXIT and clinical outcome. Keywords: Fetal surgery, Ex-Utero Intrapartum treatment (EXIT), Placental support, Fetal airway, Airway management, Neck mass
Background The “Ex-Utero Intrapartum Treatment” (EXIT) procedure allows ensuring fetal airway before completion of * Correspondence: [email protected] 1 Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Avda. Manuel Siurot s/n ES–41013, Seville, Spain 2 Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain Full list of author information is available at the end of the article
delivery and umbilical cord clamping while keeping uteroplacental circulation. Although EXIT was initially designed to reverse tracheal occlusion performed on fetuses with a severe congenital diaphragmatic hernia, its indications have expanded over the years [1–3]. Airway obstruction in fetal oropharyngeal and cervical masses can be life-threatening at birth. Nowadays, prenata
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