A multi-disciplinary team of doctors at Christian Medical College (CMC), Vellore performed EXIT (ex utero intrapartum treatment) procedure on a foetus having a neck mass recently.
EXIT procedure is a life-saving procedure done in a foetus whose air passages are obstructed either because of a large mass in the neck or in conditions like diaphragmatic hernia where the intestines, liver move up to the chest, and may prevent the baby from breathing after birth, a press release said.
A pregnant woman was referred to CMC’s labour ward at 37 weeks of pregnancy with her baby having a neck mass. A scan revealed that the foetus had a large, solid neck mass, measuring 7 x 8 cm. This was compressing its oesophagus (food pipe) and trachea (wind pipe).
While in the mother’s womb, the baby gets its oxygen supply from the mother’s blood via the placenta. After delivery, it needs to breathe on its own. It is here that the presence of airway obstruction due to the neck mass would prevent the baby from breathing on its own after birth, doctors explained, in the release.
It is here that the EXIT procedure plays a vital role. Its aim is to deliver the baby partially and keep the blood/oxygen flow from the placenta going. Meanwhile, a team of experts would pass a breathing tube into the baby’s airway so that the oxygen can be delivered to the baby’s lungs through the ventilator. The umbilical cord is then cut.
“It is a common myth that EXIT procedure is as same as caesarean section. The challenge in EXIT is that we have to keep the uterus relaxed to ensure that the placenta stays in place and the baby gets its oxygen. We need a coordinated effort and a multi-disciplinary team for EXIT procedure,” said Manisha Madhai Beck, associate professor and head of Obstetrics and Gynaecology unit 4, CMC.
She pointed out that the incidence of congenital neck tumours is around 1.7 to 13.5 per 100,000 live births. She noted that neck mass in a foetus was a rare entity and the procedure was done in very few centres.
The team comprised obstetricians, anaesthetists (general and paediatrics), paediatric otolaryngologists and neonatologists. It included Ekta Rai, head of anaesthesia unit-5, Mary John, head of paediatric ENT, Sridhar Santhanam, head of neonatology and Reeta Vijayaselvi, obstetrician. The team had a number of meetings and a mock drill before carrying out the procedure.
While the baby was delivered partially, it took seven minutes to secure the airway after which the baby was delivered completely, the release said.
