Decision-making and operative considerations for Ex-utero Intrapartum treatment (EXIT)

Abstract

The Ex-Utero Intrapartum Treatment (EXIT) is a method of delivery utilized in the setting of fetal anomalies that can lead to respiratory or cardiovascular compromise with the transition to extrauterine life. With multidisciplinary collaboration, delivery occurs with uterine relaxation to preserve placental function, allowing for appropriate intervention while the maternofetal interface is maintained. Multiple types of EXIT procedures are described in the literature that differ based on fetal indication and specific clinical goals. These include EXIT-to-airway, EXIT-to-resection, EXIT-to-extracorporeal membrane oxygenation (ECMO), and EXIT-to-ventricular pacing. When considering an EXIT procedure, fetal benefit must be weighed against maternal risk, and patients require thorough counseling to make an informed decision. In many cases, an individualized approach is necessary. The goal of this review is to provide an overview of the prenatal evaluation, risk stratification, and technical planning necessary for the various forms of EXIT procedures.