(1060) Systematic Review of Neonatal and Maternal Outcomes in Ex Utero Intrapartum Treatment Procedure for Head and Neck Pathology

Introduction: The ex utero intrapartum treatment (EXIT) procedure maintains maternal-fetal circulation during delivery to provide time for intervention in prenatally diagnosed conditions affecting the fetal airway. This systematic review aims to evaluate maternal and fetal outcomes of EXIT procedures for management of head and neck pathology, with focus on airway management and the role of the otolaryngologist.

Methods: A systematic review of articles published from 1997-2023 describing the EXIT procedure for prenatally diagnosed head and neck pathology was performed. Out of 1,646 articles that were identified (MEDLINE, Scopus, Cochrane), 92 articles were included. Exclusion criteria were studies that did not report on maternal and/or fetal outcomes, or examined procedures other than EXIT including operation on placental support (OOPS), vaginal delivery with sustained placental support (VSPS), or elective termination.

Results: A total of 211 fetuses underwent EXIT, lasting 2-158 minutes. The most common diagnoses were lymphatic malformation (n=69), teratoma (n=67), congenital high airway syndrome (CHAOS; n=36), and mandibular hypoplasia/aplasia (n=19). 78 patients required tracheostomy. A diagnosis of CHAOS was significantly more likely to require tracheostomy (p < 0.001). Mortality during EXIT was 5.7% with more than half being due to failed airway access. The rate of post-natal mortality was reported to be 14.6% leading to an overall mortality of 19.4%. Reports on maternal outcomes were limited. There were no maternal deaths reported. Only 5 cases mentioned need for maternal blood transfusion, with reported estimated blood loss ranging from 500-2,000 mL.

Conclusions: This study shows the EXIT procedure is an effective strategy for delivery of fetuses with head and neck pathology affecting the airway and underscores the critical role of an otolaryngologist during these cases. Though maternal complications are rare, the procedure does not come without risk to the fetus. Even with successful airway intervention mortality remains high, likely due to the inherent complications many of these conditions carry.