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Clinical Note
June 2006

The Ex Utero Intrapartum Treatment (EXIT) ProcedureNew Challenges

Author Affiliations

Author Affiliations: Departments of Pediatric Otolaryngology (Drs Otteson and Mandell) and Pediatric Surgery (Dr Hackam), Children's Hospital of Pittsburgh, and Departments of Surgery (Dr Hackam) and Otolaryngology (Dr Mandell), University of Pittsburgh, Pittsburgh, Pa.

Arch Otolaryngol Head Neck Surg. 2006;132(6):686-689. doi:10.1001/archotol.132.6.686

The ex utero intrapartum treatment (EXIT) procedure is a controlled technique that is designed to allow partial fetal delivery via cesarean section with subsequent establishment of a safe fetal airway by either intubation or bronchoscopy, while fetal oxygenation is maintained through attachment to placental circulation.1,2 The most common indication for the EXIT procedure is the presence of fetal airway obstruction, which is usually caused by a prenatally diagnosed neck mass. We report 3 cases involving special challenges (morbid maternal obesity, preterm labor, extreme fetal prematurity, intralesional hemorrhage, and platelet trapping) and a new indication (severe micrognathia) for the EXIT procedure. As familiarity with the EXIT procedure increases among pediatric otolaryngologists, new indications and select departures from standard EXIT protocol should be considered for unusually challenging cases, as long as meticulous preoperative planning is maintained.

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