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Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies.
Swiss Med Wkly. 2007 May 19; 137(19-20):279-85.SM

Abstract

The ex utero intrapartum treatment (EXIT) procedure is designed to guarantee sufficient oxygenation for a foetus at risk of airway obstruction. This is achieved by improving lung ventilation, usually by establishing an airway during caesarean delivery whilst preserving the foetal-placental circulation temporarily. Indications for the EXIT procedure have extended from its original use in reversing iatrogenic tracheal obstruction in congenital diaphragmatic hernia to naturally occurring upper airway obstructions. We report our experience with a new and rarely mentioned indication for the EXIT procedure, intra-thoracic volume expansions. The elaboration of lowest risk scenarios through balancing risks with alternative options, foetal or neonatal intervention and coordination between professionals from various disciplines are the most important conditions for a successful EXIT procedure. The EXIT procedure requires a caesarean section that specifically differs from the traditional caesarean section during which uterine tone is maintained to minimize maternal bleeding. To guarantee foetal oxygenation during the EXIT procedure, profound uterine relaxation is desired. To gain time with optimal placental oxygenation in order to safely perform an airway intervention in a baby at risk of hypoxia may require deep inhalation anaesthesia and/or tocolytic agents. We review the EXIT procedure and present a case series from the University Hospital of Geneva that contrasts with the common indication for the EXIT procedure usually based on upper airway obstruction by its exclusive indication for intra-thoracic malformations/diseases.

Authors+Show Affiliations

Anaesthesia, University Hospital Geneva, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

17594540

Citation

Kern, C, et al. "Ex Utero Intrapartum Treatment (EXIT), a Resuscitation Option for Intra-thoracic Foetal Pathologies." Swiss Medical Weekly, vol. 137, no. 19-20, 2007, pp. 279-85.
Kern C, Ange M, Morales , et al. Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies. Swiss Med Wkly. 2007;137(19-20):279-85.
Kern, C., Ange, M., Morales, ., Peiry, B., & Pfister, R. E. (2007). Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies. Swiss Medical Weekly, 137(19-20), 279-85.
Kern C, et al. Ex Utero Intrapartum Treatment (EXIT), a Resuscitation Option for Intra-thoracic Foetal Pathologies. Swiss Med Wkly. 2007 May 19;137(19-20):279-85. PubMed PMID: 17594540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies. AU - Kern,C, AU - Ange,M, AU - Morales,, AU - Peiry,B, AU - Pfister,R E, PY - 2007/6/28/pubmed PY - 2007/12/6/medline PY - 2007/6/28/entrez SP - 279 EP - 85 JF - Swiss medical weekly JO - Swiss Med Wkly VL - 137 IS - 19-20 N2 - The ex utero intrapartum treatment (EXIT) procedure is designed to guarantee sufficient oxygenation for a foetus at risk of airway obstruction. This is achieved by improving lung ventilation, usually by establishing an airway during caesarean delivery whilst preserving the foetal-placental circulation temporarily. Indications for the EXIT procedure have extended from its original use in reversing iatrogenic tracheal obstruction in congenital diaphragmatic hernia to naturally occurring upper airway obstructions. We report our experience with a new and rarely mentioned indication for the EXIT procedure, intra-thoracic volume expansions. The elaboration of lowest risk scenarios through balancing risks with alternative options, foetal or neonatal intervention and coordination between professionals from various disciplines are the most important conditions for a successful EXIT procedure. The EXIT procedure requires a caesarean section that specifically differs from the traditional caesarean section during which uterine tone is maintained to minimize maternal bleeding. To guarantee foetal oxygenation during the EXIT procedure, profound uterine relaxation is desired. To gain time with optimal placental oxygenation in order to safely perform an airway intervention in a baby at risk of hypoxia may require deep inhalation anaesthesia and/or tocolytic agents. We review the EXIT procedure and present a case series from the University Hospital of Geneva that contrasts with the common indication for the EXIT procedure usually based on upper airway obstruction by its exclusive indication for intra-thoracic malformations/diseases. SN - 1424-7860 UR - https://www.unboundmedicine.com/medline/citation/17594540/Ex_utero_intrapartum_treatment__EXIT__a_resuscitation_option_for_intra_thoracic_foetal_pathologies_ L2 - https://medlineplus.gov/cesareansection.html DB - PRIME DP - Unbound Medicine ER -