1. Changing indications and antenatal prognostic factors for ex‐utero intrapartum treatment procedures
- Author
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Hugh Porter, Amit Trivedi, Miguel Marquez, Peter Gibson, Sarah J. Melov, Umesh Mishra, Pranav Jani, Alan T. Cheng, Roshni Nayyar, and Thushari I. Alahakoon
- Subjects
Polyhydramnios ,Placenta ,Ex utero Intrapartum Treatment Procedures ,Micrognathism ,Infant, Newborn ,Teratoma ,Obstetrics and Gynecology ,Prognosis ,Airway Obstruction ,Pregnancy ,Humans ,Female ,Genetics (clinical) ,Retrospective Studies - Abstract
In cases of suspected neonatal airway obstruction, the ex-utero intrapartum treatment (EXIT) procedure is used to secure the airway while a fetus remains on placental circulation. We report indications and outcomes from all EXIT procedures at a tertiary obstetric unit between 1997 and 2020.Retrospective cohort study with data collected from maternal and neonatal medical records.Indications for EXIT procedures were micrognathia (n = 7), lymphatic malformations (n = 5), cervical teratomas (n = 4), goiters (n = 2), and intra-oral epulis (n = 1). Infants with a fetal teratoma were delivered earliest due to 75% presenting with preterm premature rupture of membranes or preterm labor. Low birth weight was found in 75% of these neonates; they did not survive 1 year. Intubation at EXIT occurred for 58% (n = 11) of babies, and six neonates required a tracheostomy. In four cases of fetal micrognathia, the inferior facial angle (IFA) was noted to be5th centile. All but one micrognathia case had polyhydramnios. Of the total cohort, 75% of neonates were alive at 1 year.Risks for neonatal demise with EXIT include fetal teratoma, low birth weight, and prematurity. Micrognathia has become an increasingly valid indication for the procedure. The combination of polyhydramnios and IFA5% correlates well with severe airway obstruction and suggests consideration of EXIT.
- Published
- 2022