Two Cases of Ex Utero Intrapartum Treatment (EXIT) in UP-PGH

Carlo G. Catabijan, Edgard M. Simon, Gina O. Gumintad,
Maria Lucresia A. Tan, Karmi Margaret G. Marcial and June Cathleen C. Castillo

Department of Anesthesiology, College of Medicine and
Philippine General Hospital, University of the Philippines Manila

 

The survival rate and prognosis for neonates with airway obstruction is poor if not managed immediately afeter delivery. Ex utero intrapartum treatment (EXIT) is indicated for cases in which airway obstruction is anticipated. The procedure establishes the fetal airway prior to complete delivery while maintaining an intact uteroplacental circulation. Maintaining uteroplacentral circulation, ensuring uterine relaxation, and temporizing placental detachment during the EXIT procedure are achieved by administering a higher dose of inhalation anesthetic and intravenous nitroglycerine. However, this can lead to maternal hypotension and compromised feto-placental perfusion, reduced fetal cardiac output, and acidosis. It is therefore essential that these be managed using vasopressors and inotropes. This paper reports the first institutional experience with the EXIT procedure in the Philippines, presenting two cases of neonates with large cystic hygroma. One case was performed as an elective procedure, the other as emergency treatment.

Key Words: EXIT procedure, Obstetric Anesthesia