Fetal Treatment Program of New England

EXIT Procedure

Exit Procedure

An ex utero intra-partum (EXIT) procedure is a specialized delivery, much like a Cesarean section, that is planned when there is a possibility that the newborn baby will not be able to breathe on his or her own after birth—and that it will be very difficult or impossible to insert a breathing tube. Many things can cause a newborn’s airway to be compressed, such as a number of rare congenital disorders; a mass or tumor; or in cases of fetal tracheal occlusion. Airway compression discovered at birth is a medical emergency; however, it is often discovered during prenatal ultrasound, allowing us to plan a safe delivery using the EXIT procedure.

How does it work? 

The fetus receives oxygen from the placenta, through the umbilical cord. Normally at birth, the cord is clamped and the baby takes his or her first breath. In an EXIT procedure, we deliver the neck and head of the baby, while the rest of the body and umbilical cord remain inside the uterus. This allows us to try to open the baby’s airway while he or she is still receiving oxygen through the umbilical cord.

How is it performed? 

While you are under general anesthesia, an incision will be made on the midline of your abdomen and uterus. We partially deliver the baby through the opening, while a pediatric head and neck surgeon establishes an airway so the fetus can breathe. This is done by inserting a breathing tube through the mouth or, if possible, by making a small incision in the neck and going directly into the wind pipe. 

An EXIT procedure provides up to 30-45 minutes to secure a safe access to the airway; however, the uterus and umbilical cord must stay relaxed. At birth, there is a natural tendency for the baby to come out, the umbilical cord to close, the placenta to detach and the uterus to contract. Our anesthesiologists and surgeons work to slow this process and to keep the uterus as relaxed as possible, which requires a delicate balance of medication and surgical maneuvers. Once the EXIT is complete, the umbilical cord is cut and clamped and the infant is fully delivered.