Anesthesia for Ex Utero Intrapartum Therapy

Fetuses with congenital head and neck anomalies which will result in impaired spontaneous respiration and difficulty in securing the airway after delivery may suffer asphyxia at birth. The ex utero intrapartum therapy (EXIT) offers such affected babies a chance at survival by allowing airway manipulations to occur after partial delivery of the baby, while the baby remains on utero-placental support. This very unique procedure requires extensive planning and multidisciplinary coordination with a multiplicity of specialties including maternal fetal medicine, pediatric surgery, pediatric otolaryngology, pediatric anesthesiology, neonatology, and pediatric cardiology. The preoperative planning takes place several days prior to the procedure and also involves meeting with the family. It is the intricacies of multidisciplinary team that require EXIT procedures to take place in certain highly specialized tertiary care fetal centers.