Ex utero intrapartum treatment, also called an EXIT procedure, is a surgical procedure that is used to deliver babies who have airway compression due to cervical teratomas, cystic hygromas or blockage of the airway such as congenital high airway obstruction (CHAOS) syndrome. The procedure has also been used to stabilize and perform resection for babies with massive lung lesions. It is similar to a cesarean section (C-section), but there are some important differences.
What to expect during an EXIT procedure
First, the mother always receives general anesthesia to put her to sleep during the surgery. A special uterine stapling device is used to open the uterus to prevent bleeding. Your baby is then partially delivered through the incision while remaining attached to the placenta. Anesthesia keeps the uterus soft and relaxed, which allows the placenta to continue to work.
The procedure preserves uteroplacental gas exchange so that your baby can continue to receive oxygen and nutrients from mom while the surgical team works to establish an airway that will permit your child to breathe and obtain oxygen once delivered.
Potential risks to the EXIT procedure include the risk of uterine bleeding. This risk is minimized by coordination between the surgeon and anesthesiologist. Your clinical team works closely together to decrease the concentration of inhalation anesthetic and to administer oxytocin to contract the uterus before cutting the umbilical cord.
This technique, in combination with the uterine stapling device, has kept the average intraoperative maternal blood loss well within the accepted range for traditional C-section.
The coordination of our experienced team of pediatric surgeons, fetal and maternal anesthesiologists, maternal-fetal medicine specialists, neonatologists, and obstetrical, neonatal and operating room nurses is central to achieving excellent outcomes for both mom and baby during an EXIT delivery.