title: EXIT procedure in twin pregnancy: a series of three cases from a single center.
abstract: BACKGROUND
  Indications for the ex utero intrapartum therapy (EXIT) procedure have evolved and nowadays in addition to secure the airway, obtain vascular access, administer surfactant and other resuscitation medications, EXIT is used to resect cervical or thoracic masses, for extracorporeal membrane circulation (ECMO) cannulation, as well as to rescue maximum intra-thoracic space for ventilation of the remaining functional lung tissue or in cases in which resuscitation of the neonate may be compromised. EXIT procedure in twin pregnancy has been rarely reported and some doubts have been raised about its strategy and safety in such cases.
  
  
  METHODS
  We reviewed the medical records of 3 twin pregnancy cases where the EXIT procedure have been performed in our center.
  
  
  RESULTS
  The mean gestational age at EXIT procedure was 34 + 4 weeks. In two out the three EXIT procedures, the affected twin was delivered first. The average time on placental bypass was 9 minutes. There were no fetal or maternal complications related to the EXIT procedure. All newborns are currently doing well.
  
  
  CONCLUSIONS
  In twin pregnancies, prenatal diagnosis combined with the EXIT procedure permits the formulation of a controlled delivery strategy to secure both newborns outcome. In those pregnancies, if intervention can be accomplished without compromise of the normal twin, EXIT can be considered. Our results support that EXIT procedure, if properly planned, safely provides a good outcome for both the fetuses as well as the mother.
authors: Lutgardo
authors: L
authors: García-Díaz
authors: Juan Carlos
authors: JC
authors: de Agustín
authors: Antonio
authors: A
authors: Ontanilla
authors: Maria Luisa
authors: ML
authors: Marenco
authors: Antonio
authors: A
authors: Pavón
authors: Antonio
authors: A
authors: Losada
authors: Unidad de Gestión Clínica de Genética, Reproducción y Medicina Fetal, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41003 Sevilla, Spain. guillermo.antinolo.sspa@juntadeandalucia.es.
authors: Guillermo
authors: G
authors: Antiñolo
mesh_terms: D000328:Adult; D005153:Facial Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005315:Fetal Diseases / Q000601:surgery / Q000628:therapy*; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D018743:Perinatal Care; D011247:Pregnancy; D059285:Pregnancy, Twin; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D014139:Tracheostomy; D014463:Ultrasonography
chemical_list: D011663:Pulmonary Surfactants