EXIT (Ex Utero Intrapartum Treatment Procedure) Deliveries
The Ex Utero Intrapartum Treatment Procedure (EXIT procedure) is a special delivery performed when it is anticipated that a baby, or babies in the case of twins, will have an immediate, critical problem once separated from the mother at delivery.
The purpose of an EXIT is to provide the necessary intervention to the baby before the umbilical cord is cut, avoiding the crisis and allowing for a more stable transition from placental circulation to newborn circulation.
During an EXIT procedure, the mother is placed under general anesthesia. The delivery is started similar to a cesarean section, however a special device is used to open the uterus and prevent uterine bleeding at the same time. The baby’s head and arms are delivered. Monitors are placed on the baby and IV access is obtained. The baby remains attached to the placenta, which serves as life support, while the surgeon performs the necessary procedure to stabilize the baby.
In cases of airway obstruction, an EXIT procedure gives the surgeon time to clear the baby’s airway, secure a breathing tube, and provide adequate ventilation, before the baby is separated from the mother. When the baby is stable enough for delivery, the umbilical cord is cut and the newborn is transferred to the care of the neonatologist and the pediatric surgeon.
The St. Louis Fetal Care Institute performs EXIT procedures at SSM Cardinal Glennon Children’s Medical Center and SSM St. Mary’s Health Center, depending on the individual patient’s circumstances. During an EXIT procedure, our pediatric surgery team, neonatal team and maternal team work together to assure the safety of both the mother and baby.
Similar to open fetal surgery, the mother cannot labor with future pregnancies and will require cesarean sections for all future deliveries. Mothers typically are hospitalized for three to four days after an EXIT procedure for recovery, similar to that of a cesarean delivery.
EXIT to Airway
If a baby is able to breathe independently upon exiting the womb then the umbilical cord is cut, and the baby is delivered. If the baby cannot breathe independently, then doctors can insert a breathing tube through the baby’s mouth, or perform a tracheotomy before delivery.
Exit to airway is most commonly performed on babies with:
EXIT to ECMO
If a baby’s lungs need more time to develop so the baby has the ability to obtain enough oxygen, or if there is another medical condition preventing breathing, ECMO can be used.
ECMO is short for extracorporeal membrane oxygenation and is similar to a heart and lung bypass system. It is a machine which functions just like the lungs, exchanging gasses like oxygen. If ECMO is needed, tubes are placed in the baby’s blood vessels, so that blood can be removed, run through the ECMO machine, and returned to the baby. This is done before the umbilical cord is cut.
EXIT to ECMO is most commonly used for babies with:
Exit to Resection
If there is a large, life-threatening mass or tumor, such as in severe cases of Congenital Cystic Adenomatoid Malformation (CCAM) or sacrococcygeal teratoma (SCT), then the mass can be surgically removed while the baby is still receiving placental support. This is only done when the baby cannot receive oxygen without removal of the mass.