The Ex-utero intrapartum treatment (EXIT) procedure: case report of a multidisciplinary team approach

Background and aim of the work: The EXIT-to-airway procedure is aimed to provide the time re-quired to secure airways when an extrinsic or intrinsic fetal mass raise concerns about airways control at de-livery. Due to the rarity of the procedure, we aim to provide a summary of the appropriate prenatal planning by a multidisciplinary team. Methods: Report of a case of EXIT-to-airway procedure. Results: A 30 years-old woman, G2P1 with previous cesarean section, was referred to our Unit at 34 gestational weeks due to a fetal cervical mass of 7cm. An EXIT-to-airways procedure was performed by a multidisciplinary team after ac-curate preoperative planning and the practice simulations. The partial fetal extraction and the amnioinfusion of pre-heated saline were used to prevent fetal complications. The use of supplemental intravenous anesthesia with remifentanil and better control of uterine tone with nitroglycerin allowed reducing the exposure to vola-tile halogen for both the mother and the fetus. The accurate preoperative planning and the practice simula-tions allowed us to perform the treatment safely in urgency due to the onset of spontaneous labor at 37 weeks and 6 days. Conclusions: The strong cooperation among specialists, accurate prenatal planning, and adopting all the required procedures and precautions are of paramount importance to successfully perform the EXIT-to-airway procedure