Obstet Gynecol Sci.  2018 May;61(3):417-420. 10.5468/ogs.2018.61.3.417.

Ex utero intrapartum treatment procedure in two fetuses with airway obstruction

• Lee J
• Lee MY
• Kim Y
• Shim JY
• Won HS
• Jeong E
• Lee BS
• Kim KS
• Choi WJ
• Lee YS

• KMID: 2416132
• DOI: http://doi.org/10.5468/ogs.2018.61.3.417

Abstract

The ex utero intrapartum treatment (EXIT) procedure was introduced to reduce fetal hypoxic damage while establishing an airway in fetuses with upper and lower airway obstruction. Delivery of the fetal head and shoulders while maintaining the uteroplacental circulation offers time to secure the fetal airway. Here, we report two cases of EXIT procedure for fetal airway obstruction, which were successfully managed with extensive preoperative planning by a professional multidisciplinary team.

Keyword

Fetal therapy; Laryngeal diseases; Lymphangioma; Prenatal diagnosis

MeSH Terms

Airway Obstruction*
Fetal Therapies
Fetus*
Head
Laryngeal Diseases
Lymphangioma
Placental Circulation
Prenatal Diagnosis
Shoulder

Figure

• 

  Fig. 1 Ultrasonographic findings at 30.3 weeks of gestation showing a huge heterogeneous solid mass on the fetal neck with high vascularity (A). Magnetic resonance imaging at 31.0 weeks of gestation showing an 8.5 cm-sized neck mass with suspected airway obstruction (arrow in B). After partially delivering the fetal head and shoulders, intubation was performed (C).

• 

  Fig. 2 Ultrasonographic findings showing both lung hyperexpansion with diaphragm inversion, suggestive of congenital high airway obstruction syndrome (A). Tracheostomy is in process while the baby is partially delivered (B).

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