The Ex-utero intrapartum treatment procedure: a narrative review
The “Ex Utero Intrapartum Treatment” (EXIT) procedure is a specialized surgical technique used during cesarean delivery to perform life-saving fetal interventions while maintaining placental circulation. By preserving feto-placental gas exchange, EXIT enables the treatment of severe conditions such...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1601963/full |
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| author | Michele Gaffuri Michele Gaffuri Genny Raffaeli Elena Emilia Bullejos Garcia Giuseppe Perugino Ottavio Cassardo Nicola Persico Nicola Persico Mariarosa Colnaghi Felipe Garrido Eduardo Villamor Irene Cetin Irene Cetin Monica Fumagalli Monica Fumagalli Lorenzo Pignataro Lorenzo Pignataro Giacomo Cavallaro |
| author_facet | Michele Gaffuri Michele Gaffuri Genny Raffaeli Elena Emilia Bullejos Garcia Giuseppe Perugino Ottavio Cassardo Nicola Persico Nicola Persico Mariarosa Colnaghi Felipe Garrido Eduardo Villamor Irene Cetin Irene Cetin Monica Fumagalli Monica Fumagalli Lorenzo Pignataro Lorenzo Pignataro Giacomo Cavallaro |
| author_sort | Michele Gaffuri |
| collection | DOAJ |
| description | The “Ex Utero Intrapartum Treatment” (EXIT) procedure is a specialized surgical technique used during cesarean delivery to perform life-saving fetal interventions while maintaining placental circulation. By preserving feto-placental gas exchange, EXIT enables the treatment of severe conditions such as predictable severe breathing difficulties at birth. EXIT's origins date back to removing tracheal occlusion devices used for congenital diaphragmatic hernias. It has since expanded to treat conditions such as congenital high airway obstruction syndrome and airway compression by masses. Despite the risks of adverse maternal and fetal events, it shows high perinatal survival rates. The success of EXIT depends on an accurate prenatal diagnosis through fetal ultrasound and magnetic resonance imaging. Anesthetic management differs from standard cesarean sections, balancing the need for uterine relaxation and avoiding maternal-fetal risks. Inhaled anesthetics are preferred, although recent studies suggest the potential of neuraxial anesthesia combined with tocolytics. Although the EXIT procedure can be performed safely in specialized centers, it does carry risks for both the mother and the fetus. Neonatal mortality and complications vary depending on indications and postnatal management. Research and clinical practice must advance to improve safety and efficacy. |
| format | Article |
| id | doaj-art-5f355abe099a48a08fa7a61d7c0c11a9 |
| institution | Matheson Library |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-5f355abe099a48a08fa7a61d7c0c11a92025-07-17T05:25:48ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-07-011310.3389/fped.2025.16019631601963The Ex-utero intrapartum treatment procedure: a narrative reviewMichele Gaffuri0Michele Gaffuri1Genny Raffaeli2Elena Emilia Bullejos Garcia3Giuseppe Perugino4Ottavio Cassardo5Nicola Persico6Nicola Persico7Mariarosa Colnaghi8Felipe Garrido9Eduardo Villamor10Irene Cetin11Irene Cetin12Monica Fumagalli13Monica Fumagalli14Lorenzo Pignataro15Lorenzo Pignataro16Giacomo Cavallaro17Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, Dipartimento di Eccellenza 2023-2027, University of Milan, Milan, ItalyNeonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyPediatric Anesthesia and Resuscitation Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, Dipartimento di Eccellenza 2023-2027, University of Milan, Milan, ItalyPrenatal Diagnosis and Fetal Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyNeonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyNeonatal Intensive Care Unit, Clínica Universidad de Navarra, Madrid, SpainDivision of Neonatology, MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC+), Research Institute for Oncology and Reproduction (GROW), Maastricht University, Maastricht, NetherlandsDepartment of Clinical Sciences and Community Health, Dipartimento di Eccellenza 2023-2027, University of Milan, Milan, ItalyDepartment of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, Dipartimento di Eccellenza 2023-2027, University of Milan, Milan, ItalyNeonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, Dipartimento di Eccellenza 2023-2027, University of Milan, Milan, ItalyNeonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyThe “Ex Utero Intrapartum Treatment” (EXIT) procedure is a specialized surgical technique used during cesarean delivery to perform life-saving fetal interventions while maintaining placental circulation. By preserving feto-placental gas exchange, EXIT enables the treatment of severe conditions such as predictable severe breathing difficulties at birth. EXIT's origins date back to removing tracheal occlusion devices used for congenital diaphragmatic hernias. It has since expanded to treat conditions such as congenital high airway obstruction syndrome and airway compression by masses. Despite the risks of adverse maternal and fetal events, it shows high perinatal survival rates. The success of EXIT depends on an accurate prenatal diagnosis through fetal ultrasound and magnetic resonance imaging. Anesthetic management differs from standard cesarean sections, balancing the need for uterine relaxation and avoiding maternal-fetal risks. Inhaled anesthetics are preferred, although recent studies suggest the potential of neuraxial anesthesia combined with tocolytics. Although the EXIT procedure can be performed safely in specialized centers, it does carry risks for both the mother and the fetus. Neonatal mortality and complications vary depending on indications and postnatal management. Research and clinical practice must advance to improve safety and efficacy.https://www.frontiersin.org/articles/10.3389/fped.2025.1601963/fullEx utero intrapartum treatmentEXITnewbornairway obstructiontracheal occlusioncongenital neck masses |
| spellingShingle | Michele Gaffuri Michele Gaffuri Genny Raffaeli Elena Emilia Bullejos Garcia Giuseppe Perugino Ottavio Cassardo Nicola Persico Nicola Persico Mariarosa Colnaghi Felipe Garrido Eduardo Villamor Irene Cetin Irene Cetin Monica Fumagalli Monica Fumagalli Lorenzo Pignataro Lorenzo Pignataro Giacomo Cavallaro The Ex-utero intrapartum treatment procedure: a narrative review Frontiers in Pediatrics Ex utero intrapartum treatment EXIT newborn airway obstruction tracheal occlusion congenital neck masses |
| title | The Ex-utero intrapartum treatment procedure: a narrative review |
| title_full | The Ex-utero intrapartum treatment procedure: a narrative review |
| title_fullStr | The Ex-utero intrapartum treatment procedure: a narrative review |
| title_full_unstemmed | The Ex-utero intrapartum treatment procedure: a narrative review |
| title_short | The Ex-utero intrapartum treatment procedure: a narrative review |
| title_sort | ex utero intrapartum treatment procedure a narrative review |
| topic | Ex utero intrapartum treatment EXIT newborn airway obstruction tracheal occlusion congenital neck masses |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1601963/full |
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