Abraham R J, Sau A, Maxwell D
Department of Obstetrics and Gynaecology, Huddersfield Royal Infirmary, Huddersfield, UK.
J Obstet Gynaecol. 2010 Jan;30(1):1-5. doi: 10.3109/01443610903281656.
The EXIT (Ex utero Intrapartum Treatment) procedure is done in cases where difficulty is anticipated in neonatal airway establishment at delivery and is done at the time of caesarean section. The partially delivered fetus is maintained on placental circulation while airway is established and this is carried out by a multidisciplinary team. In this paper, we review the indications, the maternal and fetal considerations of the procedure and the results and outcomes. The review highlights the fact that the benefits far outweigh the risks and that the risk of postpartum haemorrhage is more theoretical than real. As technology improves and more anomalies are diagnosed during the antenatal period, the EXIT procedure can be performed with good results after carefully considering the ethical issues. We have performed a MEDLINE search by using the keywords EXIT, CHAOS, fetal surgery, fetal neck masses and ex utero intrapartum treatment. As there are not many large studies, we have also reviewed smaller case series and case reports.
EXIT（产时宫外治疗）手术适用于预计分娩时新生儿气道建立困难的情况，在剖宫产时进行。部分娩出的胎儿在建立气道的同时维持胎盘循环，这由一个多学科团队来实施。在本文中，我们回顾了该手术的适应症、对母体和胎儿的考量以及结果和转归。该综述强调了获益远大于风险这一事实，并且产后出血的风险更多是理论上的而非实际存在的。随着技术的进步以及产前诊断出更多的畸形，在仔细考虑伦理问题后，EXIT手术可以取得良好的效果。我们使用关键词EXIT、CHAOS、胎儿手术、胎儿颈部肿块和产时宫外治疗在MEDLINE上进行了检索。由于大型研究不多，我们还回顾了较小的病例系列和病例报告。
