Nitroglycerin for relaxation to establish a fetal airway (EXIT procedure).
BACKGROUND
The ex utero intrapartum treatment (EXIT) procedure is a technique designed to establish an airway at the time of delivery in fetuses at risk of airway obstruction and requires maintenance of uterine relaxation to continue placental perfusion and prevent placental separation. We describe the use of intravenous nitroglycerin to maintain uterine relaxation during the EXIT procedure.


METHODS
A 17-year-old primigravida with a fetus known to have an anterior neck mass was admitted for a scheduled operative delivery at 38 weeks of gestation using a modified EXIT procedure. Anesthesia was administered with a combined spinal-epidural technique. Intravenous nitroglycerin was administered as a bolus and then as a continuous infusion to maintain uterine relaxation until evaluation of the neonatal airway was completed.


CONCLUSIONS
Intravenous nitroglycerin is an effective agent for maintenance of uterine relaxation and placental perfusion during the EXIT procedure.
Clark
Kelley D
KD
Department of Obstetrics and Gynecology, Fletcher Allen Health Care, University of Vermont, Burlington, Vermont 05401, USA. Kelley.Clark@vtmednet.org
Viscomi
Christopher M
CM
Lowell
Jane
J
Chien
Edward K
EK
D000293:Adolescent; D000402:Airway Obstruction / Q000517:prevention & control*; D000773:Anesthesia, Obstetrical; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D018191:Lymphangioma, Cystic / Q000000981:diagnostic imaging*; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D015149:Tocolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016216:Ultrasonography, Prenatal; D014590:Uterine Contraction / Q000187:drug effects*
D015149:Tocolytic Agents; D005996:Nitroglycerin