[EXIT: Experiences from Karolinska University Hopsital]

Lakartidningen. 2019 May 15:116:FHWM.
[Article in Swedish]

Abstract

The main, but not sole, indication for an Ex-utero Intrapartum Treatment (EXIT) delivery is an airway obstruction due to either laryngeal atresia or tumors in the head and neck region. Here we present our Institution's experience with eleven cases: three teratomas, four lymphatic malformations, two laryngeal atresias and two dermoid cysts. The EXIT procedure was used to secure the fetal airway while maintaining uteroplacental gas exchange and fetal hemodynamic stability through the umbilical circulation. Five fetuses required tracheostomy. Only one fetal death occurred due to extensive growth of a teratoma preventing us from establishing an airway. No other fetal or major maternal complication occurred. The EXIT procedure is a complex procedure and these rare cases should be referred to a center with a dedicated and experienced multidisciplinary team.

MeSH terms

  • Adult
  • Airway Obstruction* / congenital
  • Airway Obstruction* / surgery
  • Cesarean Section
  • Cystic Adenomatoid Malformation of Lung, Congenital / surgery
  • Female
  • Head and Neck Neoplasms / congenital
  • Head and Neck Neoplasms / surgery
  • Hospitals, University
  • Humans
  • Hysterotomy / methods*
  • Infant, Newborn
  • Intubation, Intratracheal / methods
  • Laparotomy / methods*
  • Laryngeal Diseases / congenital
  • Laryngeal Diseases / surgery
  • Larynx / abnormalities
  • Larynx / surgery
  • Lymphatic Abnormalities / surgery
  • Patient Care Team
  • Pregnancy
  • Pregnancy Outcome
  • Prenatal Diagnosis
  • Retrospective Studies
  • Sacrococcygeal Region / pathology
  • Sacrococcygeal Region / surgery
  • Sweden
  • Teratoma / congenital
  • Teratoma / surgery
  • Tracheotomy / methods