Role of Fetoscopic Airway Evaluation Immediately Preceding EXIT Procedure in Fetuses With Suspected Airway Obstruction

OBJECTIVE: This study describes the role of pre-EXIT (Ex Utero Intrapartum Treatment) fetoscopic airway evaluation in fetuses with suspected airway obstruction. METHODS: Single center, retrospective, observational study including fetuses with suspected airway obstruction undergoing fetoscopic airway evaluation prior to EXIT between 2013 and 2025. RESULTS: Nine fetuses underwent EXIT with previous fetoscopy at a median gestational age of 35 + 6 weeks (IQR 34 + 4, 37 + 1). The most frequent indications were cervical teratoma (n = 3) and lymphangioma (n = 3). Fetoscopy confirmed airway patency in one case (11.1%), allowing de-escalation to conventional cesarean section. Airway was secured by endotracheal intubation in seven cases (77.8%) and tracheostomy was required in one (11.1%). Survival at the delivery room was 100%, and one neonate died prior to discharge. CONCLUSION: Fetoscopic airway evaluation prior to EXIT is a valuable adjunct in fetuses with suspected airway obstruction. It can confirm the need for EXIT, optimize the trajectory for airway access, and potentially avoid tracheostomy, improving the safety and efficiency of airway management.