Biomaterial Database

A review of the EXIT (Ex utero Intrapartum Treatment) procedure. 2010

R J Abraham, and A Sau, and D Maxwell

Department of Obstetrics and Gynaecology, Huddersfield Royal Infirmary, Huddersfield, UK. ashis.sau@uhl.nhs.uk

The EXIT (Ex utero Intrapartum Treatment) procedure is done in cases where difficulty is anticipated in neonatal airway establishment at delivery and is done at the time of caesarean section. The partially delivered fetus is maintained on placental circulation while airway is established and this is carried out by a multidisciplinary team. In this paper, we review the indications, the maternal and fetal considerations of the procedure and the results and outcomes. The review highlights the fact that the benefits far outweigh the risks and that the risk of postpartum haemorrhage is more theoretical than real. As technology improves and more anomalies are diagnosed during the antenatal period, the EXIT procedure can be performed with good results after carefully considering the ethical issues. We have performed a MEDLINE search by using the keywords EXIT, CHAOS, fetal surgery, fetal neck masses and ex utero intrapartum treatment. As there are not many large studies, we have also reviewed smaller case series and case reports.

UI	MeSH Term	Description	Entries
D011183	Postoperative Complications	Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.	Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011247	Pregnancy	The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.	Gestation,Pregnancies
D011296	Prenatal Diagnosis	Determination of the nature of a pathological condition or disease in the postimplantation EMBRYO; FETUS; or pregnant female before birth.	Diagnosis, Prenatal,Fetal Diagnosis,Fetal Imaging,Fetal Screening,Intrauterine Diagnosis,Antenatal Diagnosis,Antenatal Screening,Diagnosis, Antenatal,Diagnosis, Intrauterine,Prenatal Screening,Antenatal Diagnoses,Antenatal Screenings,Diagnosis, Fetal,Fetal Diagnoses,Fetal Imagings,Fetal Screenings,Imaging, Fetal,Intrauterine Diagnoses,Prenatal Diagnoses,Prenatal Screenings,Screening, Antenatal,Screening, Fetal,Screening, Prenatal
D002585	Cesarean Section	Extraction of the FETUS by means of abdominal HYSTEROTOMY.	Abdominal Delivery,Delivery, Abdominal,C-Section (OB),Caesarean Section,Postcesarean Section,Abdominal Deliveries,C Section (OB),C-Sections (OB),Caesarean Sections,Cesarean Sections,Deliveries, Abdominal
D005260	Female		Females
D005315	Fetal Diseases	Pathophysiological conditions of the FETUS in the UTERUS. Some fetal diseases may be treated with FETAL THERAPIES.	Embryopathies,Disease, Fetal,Diseases, Fetal,Embryopathy,Fetal Disease
D005323	Fetal Monitoring	Physiologic or biochemical monitoring of the fetus. It is usually done during LABOR, OBSTETRIC and may be performed in conjunction with the monitoring of uterine activity. It may also be performed prenatally as when the mother is undergoing surgery.	Monitoring, Fetal,Fetal Monitorings,Monitorings, Fetal
D006473	Postpartum Hemorrhage	Excess blood loss from uterine bleeding associated with OBSTETRIC LABOR or CHILDBIRTH. It is defined as blood loss greater than 500 ml or of the amount that adversely affects the maternal physiology, such as BLOOD PRESSURE and HEMATOCRIT. Postpartum hemorrhage is divided into two categories, immediate (within first 24 hours after birth) or delayed (after 24 hours postpartum).	Hemorrhage, Postpartum,Delayed Postpartum Hemorrhage,Immediate Postpartum Hemorrhage,Hemorrhage, Delayed Postpartum,Hemorrhage, Immediate Postpartum,Postpartum Hemorrhage, Delayed,Postpartum Hemorrhage, Immediate
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000402	Airway Obstruction	Any hindrance to the passage of air into and out of the lungs.	Choking,Airway Obstructions,Obstruction, Airway,Obstructions, Airway