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Case Reports
. 2010:2010:273410.
doi: 10.1155/2010/273410. Epub 2010 Jan 20.

Ex utero intrapartum treatment for fetal oropharyngeal cyst

Allen W Ayres  1 , Suzanne K Pugh
Affiliations
Case Reports

Ex utero intrapartum treatment for fetal oropharyngeal cyst

Allen W Ayres et al. Obstet Gynecol Int. 2010.

Abstract

Background. A prenatally diagnosed fetal anomaly that could compromise the fetal airway at delivery can be managed safely with the ex utero intrapartum treatment (EXIT) procedure. Case. A 26-year-old healthy primigravida was diagnosed during her midtrimester anatomic ultrasound survey with a fetal oropharyngeal cystic structure located at the base of the tongue. The neonatal airway was successfully secured intrapartum using the EXIT procedure. Conclusion. Maintenance of fetoplacental circulation until the fetal airway is secured has been described for a multitude of fetal anomalies including cystic hygroma and teratoma. The literature also recounts its use for the reversal of tracheal plugging for congenital diaphragmatic hernia. A multidisciplinary approach to the antenatal and intrapartum care is essential for the successful management of these cases.

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Figures

Figure 1
Figure 1
Ultrasound image at 26-week gestation demonstrating oropharyngeal cyst (black arrow).
Figure 2
Figure 2
Intraoperative image of EXIT procedure. The fetus is delivered to level of upper abdomen with the fetal head and neck stabilized by the obstetrician. The pediatric anesthesiologist performs direct laryngoscopy.
See this image and copyright information in PMC

References

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    1. Skarsgard ED, Chitkara U, Krane EJ, Riley ET, Halamek LP, Dedo HH. The OOPS procedure (operation on placental support): in utero airway management of the fetus with prenatally diagnosed tracheal obstruction. Journal of Pediatric Surgery. 1996;31(6):826–828. - PubMed
    1. Mychaliska GB, Bealer JF, Graf JL, Rosen MA, Adzick NS, Harrison MR. Operating on placental support: the ex utero intrapartum treatment procedure. Journal of Pediatric Surgery. 1997;32(2):227–231. - PubMed
    1. Bouchard S, Johnson MP, Flake AW, et al. The EXIT procedure: experience and outcome in 31 cases. Journal of Pediatric Surgery. 2002;37(3):418–426. - PubMed

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