title: Prenatal three-dimensional ultrasound and magnetic resonance imaging evaluation of a fetal oral tumor in preparation for the ex-utero intrapartum treatment (EXIT) procedure.
abstract: Recent attempts at predelivery management of obstructed fetal airways have focused on the EXIT (ex-utero intrapartum treatment) procedure, which allows sufficient time to secure the fetal airway through preservation of uteroplacental gas exchange. We report a fetus with an exophytic oral tumor noted at 34 weeks of gestation. In this case, three-dimensional (3D) ultrasound allowed a complete and interactive evaluation of the tumor and related facial anatomy, and confirmed that access to the fetal airway was unlikely during delivery. Fetal magnetic resonance imaging (MRI) further demonstrated that the tumor originated in the nasopharynx and obstructed the upper airway. Both imaging results led to a final decision to offer an EXIT procedure for the neonate. At 36 weeks' gestation, a successful EXIT procedure was performed to reduce the risk of respiratory distress immediately after birth. This report highlights the value of 3D ultrasound and MRI as essential prerequisites for optimization of the triage process in selecting EXIT candidates.
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 100, Taiwan. e510011@ha.mc.ntu.edu.tw
authors.forename: J C
authors.initials: JC
authors.lastname: Shih
authors.forename: W C
authors.initials: WC
authors.lastname: Hsu
authors.forename: H C
authors.initials: HC
authors.lastname: Chou
authors.forename: S S
authors.initials: SS
authors.lastname: Peng
authors.forename: L K
authors.initials: LK
authors.lastname: Chen
authors.forename: Y L
authors.initials: YL
authors.lastname: Chang
authors.forename: F J
authors.initials: FJ
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D012131:Respiratory Insufficiency / Q000517:prevention & control; D016216:Ultrasonography, Prenatal