[The EXIT procedure: principles and application in congenital cervical teratomas].Rev Laryngol Otol Rhinol (Bord). 2009; 130(3):193-8.RL
The ex utero intrapartum treatment (EXIT) procedure uses uteroplacental gas exchange after caesarean section for foetus oxygenation. This placental support allows establishing an airway in the newborn in case of obstruction. Maintenance of placental perfusion requires uterine relaxation. A halogenated agent is classically use while nitroglycerine is used in the modified EXIT procedure.
We present the case of a newborn with a giant thyroid teratoma diagnosed on ultrasound at 20 weeks' gestation. At 32 weeks' gestation, a modified EXIT procedure was performed. The EXIT was successful and newborn was operated on the following day. Currently, the child is 32-month-old, has no sequelae and benefits from thyroid hormone substitution.
The EXIT procedure allows managing airway obstruction, even when complex, at birth. Nevertheless, prolonged uterine relaxation increases the risk of flooding. Because of its short half-life, nitroglycerine reduces this risk. In this case report we chose the modified EXIT procedure because the mother was young and primipara and foetal prognosis was poor.
Currently, the EXIT procedure is the technique of choice in the management of a foetal cervical mass. An exhaustive preoperative foetal workup is necessary to choose the classical or modified EXIT procedure.