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Ex Utero Intrapartum Treatment procedure in two fetuses with airway obstruction
( Joohee Lee ) , ( Mi-young Lee ) , ( Yeni Kim ) , ( Jae-yoon Shim ) , ( Hye-sung Won ) , ( Pil-ryang Lee ) , ( Ahm Kim )
UCI I410-ECN-0102-2019-500-001582158
This article is 4 pages or less.

The ex utero intrapartum treatment (EXIT) procedure was introduced to reduce fetal hypoxic damage while establishing an airway in fetuses with upper and lower airway obstruction. Delivery of the fetal head and shoulders while maintaining the uteroplacental circulation offers adequate time to secure the airway while preventing fetal hypoxia. Here, we report two cases of fetal airway obstruction that were successfully managed using the EXIT procedure, with extensive preoperative planning and under a professional multidisciplinary team. Case 1: A 32-year-old woman was referred to our institution at 20 weeks of gestation with a diagnosis of a fetal neck mass. Ultrasonographic and magnetic resonance imaging findings revealed a 8.5cm-sized huge lymphangioma with suspected upper airway compression. Delivery was accomplished by a cesarean section with the EXIT procedure at 38.3 weeks of gestation. The fetus was endotracheally intubated while maintaining uteroplacental circulation. The baby is now 18 months old and does not show any signs of developmental or cognitive delay. Case 2: A 31-year-old woman was referred to our institution at 21 weeks of gestation with suspected congenital high airway obstruction syndrome (CHAOS). Ultrasonography revealed symmetrically enlarged, hyperechoic, and homogeneous lungs with an inverted diaphragm, anteriorly displaced heart, and polyhydramnios, all of which were suggestive of CHAOS. The baby was delivered via the EXIT procedure at 38 weeks of gestation, and a tracheostomy was performed. The baby is now five months old and is developing normally.

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