Ex utero intrapartum technique

Upper airway obstruction of a neonate constitutes an emergency. The ex utero intrapartum technique (EXIT) is a procedure for safely managing airway obstruction at birth, in which placental support is maintained until the airway is evaluated and secured. The anaesthetist is involved in preventing uterine contractions that impair oxygenation of the foetus and cause placental separation, in providing foetal anaesthesia to help airway manipulations, in maintaining foetal pattern of circulation, in preventing and treating maternal hypotension and in resuscitating the neonate. General anaesthesia with high concentration of inhalational agents is preferred as it provides surgical tocolysis and foetal anaesthesia. Additional uterine relaxation may be obtained using tocolytic drugs like nitroglycerin or β-adrenergic agonists. During EXIT the foetus is delivered only as far as the shoulders or thorax leaving the cord entirely in utero to maximize the duration of placental support and to minimize heat and water loss. In this position foetal airway is examined and secured, which may involve tracheal intubation, bronchoscopy or tracheostomy. The umbilical cord is divided and the neonate is completely delivered only after the airway has been secured. With EXIT, a potential life-threatening emergency at birth can be managed like an elective procedure that can improve the prognosis for foetuses with airway obstruction.