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.