EXIT procedure in twin pregnancy: a series of three cases from a single center

BMC Pregnancy and Childbirth

Guillermo Antiñolo³  Antonio Losada⁴  Antonio Pavón⁴  Maria Luisa Marenco¹  Antonio Ontanilla⁵  Juan Carlos de Agustín⁶  Lutgardo García-Díaz² 

[1] Servicio de Anestesiología Hospital de La Mujer, Hospital Universitario Virgen Del Rocío, 41013 Sevilla, Spain;Unidad de Gestión Clínica de Genética, Reproducción y Medicina Fetal. Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41003 Sevilla, Spain;Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Sevilla, Spain;Unidad De Gestión Clínica De Neonatología, Hospital Universitario Virgen Del Rocío, 41013 Sevilla, Spain;Servicio de Anestesiología Hospital Infantil, Hospitales Universitarios Virgen Del Rocío, 41013 Sevilla, Spain;Unidad de Gestión Clínica de Cirugía Infantil, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain

关键词: Ex utero intrapartum therapy (EXIT) procedure;    Twin pregnancy;    Fetal intervention;    Fetal medicine;    Prenatal diagnosis;   

Others  :  1125761
DOI  :  10.1186/1471-2393-14-252

 received in 2014-05-23, accepted in 2014-07-16,  发布年份 2014

【 摘 要 】

Background

Indications for the ex utero intrapartum therapy (EXIT) procedure have evolved and nowadays in addition to secure the airway, obtain vascular access, administer surfactant and other resuscitation medications, EXIT is used to resect cervical or thoracic masses, for extracorporeal membrane circulation (ECMO) cannulation, as well as to rescue maximum intra-thoracic space for ventilation of the remaining functional lung tissue or in cases in which resuscitation of the neonate may be compromised. EXIT procedure in twin pregnancy has been rarely reported and some doubts have been raised about its strategy and safety in such cases.

Methods

We reviewed the medical records of 3 twin pregnancy cases where the EXIT procedure have been performed in our center.

Results

The mean gestational age at EXIT procedure was 34 + 4 weeks. In two out the three EXIT procedures, the affected twin was delivered first. The average time on placental bypass was 9 minutes. There were no fetal or maternal complications related to the EXIT procedure. All newborns are currently doing well.

Conclusion

In twin pregnancies, prenatal diagnosis combined with the EXIT procedure permits the formulation of a controlled delivery strategy to secure both newborns outcome. In those pregnancies, if intervention can be accomplished without compromise of the normal twin, EXIT can be considered. Our results support that EXIT procedure, if properly planned, safely provides a good outcome for both the fetuses as well as the mother.

【 授权许可】

   
2014 García-Díaz et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Harrison MR, Adzick NS, Flake AW, VanderWall KJ, Bealer JF, Howell LJ, Farrell JA, Filly RA, Rosen MA, Sola A, Goldberg JD: Correction of congenital diaphragmatic hernia in utero VIII: response of the hypoplastic lung to tracheal occlusion. J Pediatr Surg 1996, 31:1339-48.
• [2]Flake AW, Crombleholme TM, Johnson MP, Howell LJ, Adzick NS: Treatment of severe congenital diaphragmatic hernia by fetal tracheal occlusion: clinical experience with fifteen cases. Am J Obstet Gynecol 2000, 183:1059-66.
• [3]Hedrick HL, Flake AW, Crombleholme TM, Howell LJ, Johnson MP, Wilson RD, Adzick NS: The ex utero intrapartum therapy for high-risk fetal lung lesions. J Pediatr Surg 2005, 40:1038-44.
• [4]Hedrick HL, Flake AW, Crombleholme TM, Howell LJ, Johnson MP, Wilson RD, Adzick NS: Ex utero intrapartum treatment with extracorporeal membrane oxygenation for severe congenital diaphragmatic hernia. J Pediatr Surg 2007, 42:98-104.
• [5]Hedrick HL: Ex utero intrapartum therapy. Semin Pediatr Surg 2003, 10:190-5.
• [6]Bouchard S, Johnson MP, Flake AW, Howell LJ, Myers LB, Adzick NS, Crombleholme TM: The EXIT procedure: experience and outcome in 31 cases. J Pediatr Surg 2002, 37:418-26.
• [7]Antiñolo G, De Agustin JC, Losada A, Marenco ML, Garcia-Diaz L, Morcillo J: Diagnosis and management of fetal intrapericardial Morgagni diaphragmatic hernia with massive pericardial effussion. J Pediatr Surg 2010, 45(2):424-6.
• [8]Antiñolo G, de Agustín JC, Losada A, Ontanilla A, Perla AG: Diagnosis and management of a large oropharyngeal teratoma (epignathus) in a twin pregnancy. Int J Gynaecol Obstet 2009, 104(2):143-4.
• [9]Liechty KW, Crombleholme TM, Weiner S, Bernick B, Flake AW, Adzick NS: The ex utero intrapartum treatment procedure for a large fetal neck mass in a twin gestation. Obstet Gynecol 1999, 93(5 Pt 2):824-5.
• [10]Midrio P, Zadra N, Grismondi G, Suma V, Pitton MA, Salvadori S, Gamba P: EXIT procedure in a twin gestation and review of the literature. Am J Perinatol 2001, 18(7):357-62.
• [11]Marenco ML, Márquez J, Ontanilla A, García-Díaz L, Rivero M, Losada A, Torrejón R, Sainz JA, Antiñolo G: Intrauterine myelomeningocele repair: experience of the fetal medicine and therapy program of the Virgen de Rocío University Hospital. Rev Esp Anestesiol Reanim 2013, 60(1):47-53.