title: Evolving indications for the EXIT procedure: the usefulness of combining ultrasound and fetal MRI.
abstract: The EXIT procedure (EX utero Intrapartum Treatment) encompasses a multidisciplinary approach to situations in which airway obstruction is anticipated. Uteroplacental circulation is maintained to avoid neonatal hypoxemia while intubation is attempted. Not only is it useful in congenital diaphragmatic hernia with intrauterine tracheal occlusion, but new indications have been proposed. We present two cases in which EXIT procedure was adopted (huge cervical mass with tracheal compression and a highly vascularized cephalocervical mass) for the same purpose on different grounds. Our two cases stress once more the importance of combining fetal ultrasound and magnetic resonance imaging in the characterization of cervical masses and its usefulness in programming the procedure with a multidisciplinary team.
authors.affiliation: Center of Prenatal Diagnosis, Department of Gynecology and Obstetrics, University of Porto, Hospital S João, and Imagiology, SMIC, Porto, Portugal.
authors.forename: Raquel
authors.initials: R
authors.lastname: Mota
authors.forename: Carla
authors.initials: C
authors.lastname: Ramalho
authors.forename: Joaquim
authors.initials: J
authors.lastname: Monteiro
authors.forename: Jorge
authors.initials: J
authors.lastname: Correia-Pinto
authors.forename: Manuela
authors.initials: M
authors.lastname: Rodrigues
authors.forename: Hercília
authors.initials: H
authors.lastname: Guimarães
authors.forename: Jorge
authors.initials: J
authors.lastname: Spratley
authors.forename: Filipe
authors.initials: F
authors.lastname: Macedo
authors.forename: Alexandra
authors.initials: A
authors.lastname: Matias
authors.forename: Nuno
authors.initials: N
authors.lastname: Montenegro
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000601:surgery; D005865:Gestational Age; D006258:Head and Neck Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D020883:Hysterotomy; D007442:Intubation, Intratracheal / Q000379:methods; D050498:Live Birth; D018191:Lymphangioma, Cystic / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D018317:Nerve Sheath Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D021041:Placental Circulation; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000379:methods*