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Gynecology & Obstetrics

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Ex-Utero Intrapartum Treatment

What is ex-utero intrapartum treatment?

Before the baby is born it receives oxygen and nutrients through the placenta. The oxygen from the placenta reaches the baby through its umbilical cord, so the baby does not need to use its lungs before birth. Once the baby is delivered and takes its first breath, the lungs start working and the oxygen supply from the placenta is no longer required. Typically the placenta detaches with the first contraction that follows delivery of the baby and is delivered following that. 

Under rare circumstances, fetal anomalies can obstruct the airways. When this occurs the baby is fine up until delivery because the placenta fulfills the function of the lungs. But when the baby is delivered and tries to take its first breath it cannot fill its lungs with air. If the placenta detaches the baby has no way of getting oxygen into its body and requires emergent measures to stay alive.

Ex-utero intrapartum treatment (EXIT) refers to a special technique where the baby is delivered through an incision in the uterus and a functioning airway is established before separation from the placenta. To accomplish this, the uterus is kept in a relaxed state to prevent detachment of the placenta, allowing the baby to continuously receive oxygen from the mother until its airway is secured. Doing an EXIT procedure can save babies in conditions where critical restriction of the airways is suspected prior to delivery.  

What is necessary to perform a successful EXIT procedure?

The first step is to identify babies that require airway support at the time of delivery. This is achieved by high-resolution 2-D and 3-D ultrasound examination of the head and neck region. In addition, ultrafast magnetic resonance imaging offers additional critical information. When the prenatal diagnostic testing is completed, the team of experts that is going to be present at the time of delivery discusses the management strategy that will be required.

A good outcome for the mother and fetus depends on the collaborative planning of the team of experts available at the Johns Hopkins Center for Fetal Therapy. In addition to the Fetal Therapy team, Obstetric and Pediatric Anesthesiology, Neonatology and appropriate pediatric surgical specialties are all present at the time of delivery to provide the baby a safe transition to extrauterine life.