The ex utero intrapartum treatment (EXIT) procedure in fetal neck mass: A video clip = The ex utero intrapartum treatment (EXIT) procedure in fetal neck mass: A video clip

다국어 초록 (Multilingual Abstract)

Ex utero intrapartum treatment [EXIT] procedure is considerable for fetal neck mass. This procedure allows the fetus to remain perfused by the placental circulation after being partially delivered, so that life-saving treatment can be performed before delivery of placenta. A 27-year-old woman, primigravida, was referred to our center for evaluation of fetal neck mass. Level II ultrasonography, and prenatal MRI showed that fetus had no other gross anomalies except the left neck mass. This lesion in the neck was revealed as a 12 cm sized cystic lymphangioma. Timed cesarean section was scheduled and EXIT procedure was prepared by a multidisciplinary team, include OBGY, PED, AN, and ENT doctors and nurses. The EXIT procedure has conducted in the following manners. Uterine relaxation with deep general anesthesia and tocolytic agent. Sutures of uterine incision site to decrease uterine entry bleeding. Delivery of the fetus (head, neck, and both shoulders). Maintenance of uterine volume during the procedure via continuous amnioinfusion of warm saline to prevent placental separation. Establishment of an airway by intubation before cord clamping. Intraoperative sonography to check uteroplacental perfusion and fetal heart rate before cord clamping. Uterotonic agent administration after placental delivery. The EXIT procedure was used successfully to secure the fetal airway. On Day 2, intra-lesional injection of picibanil was proceeded and postnatal MRI, ultrasound showed reduced the volume of neck mass of the neonate. The EXIT procedure do require careful preparations. During operation, fetal condition can be ensured by intraoperative sonography. It is recommended to try a simulation with team several times to reduce error like contamination of operative field. The EXIT procedure should be performed by multidisciplinary team approach on tertiary center. Because there are possibilities of failure to secure the fetal airway, preparation for the tracheostomy is always needed.