Standard Operating Procedures Ex Utero Intrapartum Therapy (EXIT)

Abstract EXIT, or Ex Utero Intrapartum Treatment, is a sophisticated technique designed to ensure a safe and effective transition for a fetus from the womb to the outside world while maintaining essential placental support. The applications of the EXIT approach are continually expanding and encompass various scenarios like facilitating airway access, conducting surgical resections, implementing extracorporeal membrane oxygenation (ECMO), and aiding in the separation of conjoined twins. The method involves carefully planned delivery of fetus through hysterotomy, all the while keeping the uterus relaxed and ensuring placental assistance. This approach allows for the gradual establishment of neonatal cardiopulmonary stability in a controlled manner. The range of fetal interventions during the EXIT procedure is diverse, including tasks such as endotracheal intubation, tracheostomy, mass excision, removal of temporary tracheal devices, and ECMO. A pivotal factor in the success of an EXIT procedure is the formation of a highly skilled and collaborative multidisciplinary team. This team, equipped with broad expertise in fetal intervention, works seamlessly across the stages of pre-, intra-, and postpartum care, ensuring the best possible outcomes for the mother and the newborn.