Short-term maternal outcomes that are associated with the EXIT procedure, as compared with cesarean delivery.
OBJECTIVE
The ex utero intrapartum treatment procedure was developed to treat iatrogenic tracheal obstruction that resulted from in utero fetal therapy for congenital diaphragmatic hernia. The ex utero intrapartum treatment procedure allows for controlled intubation while the neonate is maintained on placental circulation, prolonging operative time. This study evaluates whether there is increased maternal morbidity associated with this procedure compared with routine cesarean deliveries.


METHODS
Maternal outcomes on 34 patients who underwent the ex utero intrapartum treatment procedure were evaluated. Infection rate, estimated blood loss, need for transfusion, and length of postoperative hospital stay were compared to maternal outcomes from 52 non-laboring patients who underwent non-emergent primary cesarean delivery of singleton fetuses during the same time interval.


RESULTS
The rate of chorioamnionitis was similar between groups (26% vs 21%; P =.57). Postpartum wound complications were more common in patients who underwent ex utero intrapartum treatment (15% vs 2%; P =.03), although the rate of endometritis was similar (15% vs 10%; P =.50). Estimated blood loss was higher in the patients who underwent ex utero intrapartum treatment (1104 mL vs 883 mL; P <.001), but there was no difference between groups in hematocrit level change or postpartum hospital stay.


CONCLUSIONS
Women who undergo the ex utero intrapartum treatment procedure experience more wound complications but no difference in postoperative hematocrit level change or postpartum length of stay.
Noah
Melinda M Scully
MM
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 94143, USA. noahm@obgyn.ucsf.edu
Norton
Mary E
ME
Sandberg
Per
P
Esakoff
Tania
T
Farrell
Jody
J
Albanese
Craig T
CT
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001623:Betamethasone / Q000008:administration & dosage; D016063:Blood Loss, Surgical; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000453:epidemiology / Q000209:etiology; D004716:Endometritis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005322:Premature Rupture of Fetal Membranes; D005865:Gestational Age; D006400:Hematocrit; D006548:Hernia, Diaphragmatic / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D011183:Postoperative Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D015145:Tocolysis; D014133:Tracheal Diseases / Q000209:etiology / Q000601:surgery*
D000900:Anti-Bacterial Agents; D001623:Betamethasone