title: The ex utero intrapartum treatment (EXIT) procedure: application of a new therapeutic paradigm.
abstract: The ex utero intrapartum treatment (EXIT) procedure is a term given to a technique that can transform a potentially fatal neonatal emergency to a controlled intervention with an improved outcome. It has revolutionised the care of prenatally diagnosed congenital malformations in which severe upper airway obstruction is anticipated. An extended period of utero-placental circulation can be utilised to avoid profound cardiopulmonary compromise. Its therapeutic applications have been broadened to include fetuses with congenital diaphragmatic hernia after tracheal plugging, high-risk intrathoracic masses, severe cardiac malformations and conjoined twins. It requires the co-ordination of a highly skilled and experienced multidisciplinary team. The recent enthusiasm for the EXIT procedure needs to be balanced against maternal morbidity. Specific indications and guidelines are likely to be refined as a consequence of ongoing advances in fetal intervention and antenatal imaging.
authors.affiliation: Starship Children's Health, Auckland, New Zealand.
authors.forename: Kiarash
authors.initials: K
authors.lastname: Taghavi
authors.forename: Spencer
authors.initials: S
authors.lastname: Beasley
mesh_terms: D000402:Airway Obstruction / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006258:Head and Neck Neoplasms / Q000151:congenital / Q000175:diagnosis / Q000601:surgery; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011296:Prenatal Diagnosis
keywords: congenital diaphragmatic hernia; congenital high airway obstruction syndrome (CHAOS); ex utero intrapartum treatment (EXIT) procedure; fetal airway management; neck mass