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flow of fetal lung fluid and to stimulate lung expansion and growth. With the airway obstructed, airway management at birth is critical. The solution was to arrange delivery in such a way that the occlusion could be removed and the airway secured while the baby remained on placental support. If the uterus was kept relaxed and the utero-placental blood flow kept intact, the fetus could remain on a maternal 'heart-lung machine' while the airway was secured. While the technique of tracheal occlusion remains under study in clinical trials, EXIT procedures have been shown to be useful for management of other causes of fetal airway obstruction.
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The ex utero intrapartum treatment (EXIT) procedure was originally developed to reverse temporary tracheal occlusion in patients who had undergone fetal surgery for severe congenital diaphragmatic hernia (CDH). In a select group of fetuses with CDH, tracheal occlusion is used to obstruct the normal
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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
116:, while a pediatric otolaryngologist-head & neck surgeon establishes an airway so the fetus can breathe. Once the EXIT is complete, the umbilical cord is clamped then cut and the infant is fully delivered. Then the remainder of the C-section proceeds.
96:. Airway compression discovered at birth is a medical emergency. In many cases, however, the airway compression is discovered during prenatal ultrasound exams, permitting time to plan a safe delivery using the EXIT procedure or other means.
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contractions of the uterus so that there is sufficient time to establish the airway. Also, the umbilical cord should not be manipulated, but should be kept in warmed fluids to avoid physiological occlusion.
108:, 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
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EXIT procedure: With only the baby's head and shoulders delivered, a pediatric surgeon establishes access to the airway, while the baby continues to receive oxygen through the umbilical cord.
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Hirose S, Farmer DL, Lee H, Nobuhara KK, Harrison MR (2004). "The ex utero intrapartum treatment procedure: Looking back at the EXIT".
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Bouchard S, Johnson MP, Flake AW, et al. (2002). "The EXIT procedure: experience and outcome in 31 cases".
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Adzick NS (September 2003). "Management of fetal lung lesions".
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EXIT Procedure at SSM Health St. Louis Fetal Care
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503:Lecithin–sphingomyelin ratio
480:Fetal scalp stimulation test
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232:Chestnut, David H. (2004).
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722:Resuscitative hysterotomy
609:Assisted vaginal delivery
566:External cephalic version
475:Fetal scalp blood testing
450:Chorionic villus sampling
422:Vibroacoustic stimulation
385:Obstetric ultrasonography
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412:Contraction stress test
407:Fetal movement counting
270:10.1053/jpsu.2002.30839
513:Fetal fibronectin test
662:Wood's screw maneuver
677:Third stage of labor
495:Kleihauer–Betke test
432:Amniotic fluid index
236:. St. Louis: Mosby.
78:congenital disorders
732:Postpartum bleeding
712:On maternal request
649:Dystocia management
629:Obstetrical forceps
508:Lamellar body count
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764:Categories
619:Episiotomy
338:childbirth
145:References
124:Challenges
48:obstetrics
601:Induction
470:Fetoscopy
465:Quad test
334:pregnancy
44:Specialty
707:Elective
583:Delivery
490:Apt test
443:Sampling
278:11877660
215:14533890
180:15017555
133:See also
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