Ex Utero Intrapartum Treatment (EXIT Procedure)

An ex utero intrapartum treatment (or EXIT procedure) is a highly-specialized surgical delivery procedure used to deliver babies at the Colorado Fetal Care Center. This procedure is used to deliver babies who will have an immediate, critical problem once delivered and who will be unable to breathe or transition safely from fetal life when separated from their mother.

The purpose of an EXIT procedure is to give surgeons the time they need to intervene surgically and stabilize your baby before the umbilical cord is cut. EXIT involves an innovative approach to anesthesia, which is designed to protect the health of you and your unborn baby (or babies, in the case of twins). This delivery method allows the surgical team to avoid a potential crisis and obtain a better outcome by treating your baby within a controlled environment. The EXIT procedure allows doctors to create a more stable transition from the womb to the outside world.

This complex intervention is different from a Cesarean section (C-section). While an opening is made to open the abdomen and uterus, management of the pregnancy is very unique while still preserving the baby's connection to the mother until the baby is ready to be separated. During the EXIT procedure, surgeons use special equipment that prevents bleeding and allows the baby to safely leave the womb.

When do our surgeons perform an EXIT procedure?

We deliver babies via an EXIT procedure in situations where they'd have either trouble breathing or decompensation of the heart function upon delivery, such as when:

• There's airway compression due to neck masses or tumors
• There's blockage of the airway
• There's a need to stabilize and remove lung lesions that will prevent breathing

For example, in cases of airway obstruction, an EXIT procedure gives the surgical team time to clear or establish an airway so your child can breathe and obtain enough oxygen once delivered.

What to expect during an EXIT procedure

Similar to a C-section, we perform an EXIT procedure on the day you deliver your baby.

During the EXIT procedure, your surgical team will:

• Put you to sleep using general anesthesia
• Make an incision in your lower abdomen
• Insert a special device that opens the uterus and prevents bleeding
• Partially deliver your baby by exposing the baby's head and arms while leaving the baby attached to the umbilical cord and placenta
• Perform any lifesaving procedures your baby needs
• Deliver your baby and cut their umbilical cord

The EXIT procedure is unique, as the anesthesia keeps the uterus soft and relaxed, which allows the placenta to keep working. It's like life support; your baby continues to receive oxygen and nutrients while the surgical team performs any procedures your baby needs.

What conditions require me to deliver via EXIT?

Your care team will determine whether or not you should deliver via EXIT at the time of delivery. If your baby is diagnosed with one of the following conditions and it's suspected that they may have trouble breathing on their own, EXIT may be recommended:

• Congenital diaphragmatic hernia following balloon occlusion (CDH)
• Severe congenital heart defects
• Neck masses
• Lung masses
• Chest or lung masses and tumors (like congenital pulmonary airway malformation)
• Congenital high airway obstruction syndrome (CHAOS)

Are there different types of EXIT procedures?

Your specialized fetal surgeon will perform one of the following procedures according to your baby's specific health problem:

• EXIT to airway: If your baby can't breathe independently, the fetal surgeon will perform an EXIT to airway procedure. Before delivery, the surgical team will insert a breathing tube through the baby's mouth or, if necessary, perform a tracheotomy.
• EXIT to resection: If your baby has a large, life-threatening mass or tumor and can't receive oxygen until it's removed, then the surgical team will perform EXIT to resection. We'll surgically remove the mass while your baby is still attached to the placenta and then, once the mass has been successfully removed, cut the umbilical cord and deliver your child.
• EXIT to ventricular pacing: If your baby has a complete atrioventricular block (CAVB), "rescue pacing" may be needed to make your baby's heart pump normally. With EXIT to ventricular pacing, a fetal surgeon can place pacing leads – essentially a pacemaker – on your baby before delivery.

Why should I choose the Colorado Fetal Care Center to undergo an EXIT procedure?

An EXIT delivery requires a perfectly coordinated surgical and delivery plan, complete with all of the multidisciplinary specialists you and your baby may need before, during and after delivery.

Here at the Colorado Fetal Care Center, that's exactly what we provide. During your first visit, you'll meet with every member of the care team that is dedicated to achieving the best outcome for you and your babies.

Our multidisciplinary team will collaborate to design, create and execute a perfectly coordinated treatment and surgical plan tailored to your pregnancy and your child's condition. We'll perform your EXIT procedure in a specially designed operating room where we have the equipment, experts and expertise vital to manage any situation or complication.

We've designed the Colorado Fetal Care Center so that the specially designed labor and delivery, fetal surgery suite, Neonatal Intensive Care Unit (NICU) and Maternal Fetal Care Unit (MFCU) are only steps away from each other. This provides patients and families a seamless transition from EXIT and delivery to finally holding your baby in your arms.

Contact our fetal care center

For more information about the Colorado Fetal Care Center, please call 1-720-777-4463. You can also visit our fetal care center to see firsthand how we help families plan for the road ahead.