Diawtipsukon Sanpon, Moradokkasem Woraluk, Chansriniyom Nareenun, Nuntnarumit Pracha
Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Int J Gynaecol Obstet. 2025 May;169(2):474-484. doi: 10.1002/ijgo.16060. Epub 2024 Dec 5.
The ex-utero intrapartum treatment (EXIT) procedure is a specialized delivery strategy that extends utero-placental-fetal circulation to convert a potential neonatal emergency condition into a condition that is compatible with postnatal life. Cesarean section with operation on placental support is an EXIT technique that requires a relatively short duration of placental support and few skilled medical personnel and specialized instruments; it can successfully treat selected fetal indications. In the present study, we report a case of fetal thyroid goiter as an example of a fetal anomaly requiring the procedure. We then review all cases published in the medical literature that were similar to our procedure (15 cases including our new case). Twelve (80%) cases of fetal anomalies and three prophylactic cases of extremely low birth weight were delivered using a procedure adapted from the standard EXIT procedure. All 12 cases of fetal anomalies were treated by airway intervention. In 12 of the 15 cases (80%), direct laryngoscopy and endotracheal intubation were attempted; intubation was successful in seven of these 12 cases (58%). There was only one case of postpartum hemorrhage caused by uterine incisional bleeding, with a consequence of delayed hysterotomy closure. In summary, cesarean section with operation on placental support is a promising alternative delivery technique for neonates with airway obstructive lesions, especially in resource-limited settings.
子宫外产时处理（EXIT）程序是一种特殊的分娩策略，它能延长子宫 - 胎盘 - 胎儿循环，将潜在的新生儿紧急情况转变为与出生后生活相适应的状况。胎盘支持下剖宫产是一种EXIT技术，所需的胎盘支持时间相对较短，且需要的技术娴熟的医务人员和专业器械较少；它能成功治疗特定的胎儿指征。在本研究中，我们报告了一例胎儿甲状腺肿的病例，作为需要该程序的胎儿异常的一个例子。然后我们回顾了医学文献中发表的所有与我们的程序相似的病例（包括我们的新病例在内共15例）。12例（80%）胎儿异常病例和3例极低出生体重儿预防性病例采用了改编自标准EXIT程序的方法分娩。所有12例胎儿异常病例均通过气道干预进行治疗。在15例中的12例（80%）中尝试了直接喉镜检查和气管插管；这12例中有7例（58%）插管成功。仅1例因子宫切口出血导致产后出血，结果是子宫切开术关闭延迟。总之，胎盘支持下剖宫产对于患有气道阻塞性病变的新生儿是一种有前景的替代分娩技术，尤其是在资源有限的环境中。
