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Review
. 2025 Jul 17:13:1601963.
doi: 10.3389/fped.2025.1601963. eCollection 2025.

The Ex-utero intrapartum treatment procedure: a narrative review

Michele Gaffuri #  1   2 , Genny Raffaeli #  3 , Elena Emilia Bullejos Garcia  4 , Giuseppe Perugino  5 , Ottavio Cassardo  5 , Nicola Persico  2   6 , Mariarosa Colnaghi  3 , Felipe Garrido  7 , Eduardo Villamor  8 , Irene Cetin  2   5 , Monica Fumagalli  2   3 , Lorenzo Pignataro  1   2 , Giacomo Cavallaro  3
Affiliations
Review

The Ex-utero intrapartum treatment procedure: a narrative review

Michele Gaffuri et al. Front Pediatr. .

Abstract

The "Ex Utero Intrapartum Treatment" (EXIT) procedure is a specialized surgical technique used during cesarean delivery to perform life-saving fetal interventions while maintaining placental circulation. By preserving feto-placental gas exchange, EXIT enables the treatment of severe conditions such as predictable severe breathing difficulties at birth. EXIT's origins date back to removing tracheal occlusion devices used for congenital diaphragmatic hernias. It has since expanded to treat conditions such as congenital high airway obstruction syndrome and airway compression by masses. Despite the risks of adverse maternal and fetal events, it shows high perinatal survival rates. The success of EXIT depends on an accurate prenatal diagnosis through fetal ultrasound and magnetic resonance imaging. Anesthetic management differs from standard cesarean sections, balancing the need for uterine relaxation and avoiding maternal-fetal risks. Inhaled anesthetics are preferred, although recent studies suggest the potential of neuraxial anesthesia combined with tocolytics. Although the EXIT procedure can be performed safely in specialized centers, it does carry risks for both the mother and the fetus. Neonatal mortality and complications vary depending on indications and postnatal management. Research and clinical practice must advance to improve safety and efficacy.

Keywords: EXIT; Ex utero intrapartum treatment; airway obstruction; congenital neck masses; lymphatic malformations; newborn; tracheal occlusion; vascular abnormalities.

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Conflict of interest statement

The author(s) declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
(A,B) direct laryngoscopy intubation of a fetus with a venous malformation of the tongue.
Figure 2
Figure 2
High-definition video laryngoscopy visualizing the fetal larynx during an EXIT delivery.
Figure 3
Figure 3
(A,B) surgical tracheotomy in EXIT of a fetus with laryngeal atresia.
Figure 4
Figure 4
The complexity of the operating room during the EXIT procedure and the professional roles involved. Created in https://BioRender.com.
Figure 5
Figure 5
Instruments for advanced airway management operated by neonatologists or ENT surgeons. Created in https://BioRender.com.
See this image and copyright information in PMC

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