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The Ex Utero Intrapartum Therapy (EXIT) procedure is a surgery in which a doctor corrects a problem on a baby before the umbilical cord is cut. This surgery is often done on a baby who would not be able to survive on his own unless the surgery was done. Instead of clamping and cutting the umbilical cord, a baby undergoing an EXIT procedure remains connected to his mother during the operation. This provides the baby with oxygen via the mother while the doctors operate. Without this oxygen, the time a doctor would have to operate on the baby could be severely minimized.
There are times when an unborn baby has a medical problem that could threaten his life. For instance, there may be a tumor blocking the baby's airway that could prevent him from breathing once he exits the womb. In such cases, a doctor may opt to perform the EXIT procedure. Using the umbilical cord as a sort of life line, the doctors can perform surgery on the child without the immediate threat of the baby dying or suffering brain damage because of lack of oxygen. In the case of a blocked airway, the attached umbilical cord can extend the amount of time a doctor can use to establish or reopen a baby's airway from about four minutes to about 45-60 minutes.
The EXIT procedure can be seen as two surgeries in one. First, there is a Caesarian section (C-section) to deliver the baby, and then there is the procedure to correct the medical issue threatening the baby. Since there are two concurrent surgeries, there are usually two teams present in the delivery room. One team performs the C-section, and the other performs the surgery on the baby. The two teams have to coordinate in order to perform the two procedures successfully.
There are risks associated with the EXIT procedure. First, there is the normal risk common to many C-sections. For example, the mother could have an adverse reaction to the anesthesia or can develop an infection. Risks also exist in association with the surgery on the baby during the EXIT procedure. For example, there is a risk that the placenta could detach from the mother before the surgery on the baby is complete. In addition, the mother may lose more blood because her uterus is being kept open for a longer period of time.