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Open Access Research article

EXIT procedure in twin pregnancy: a series of three cases from a single center

Lutgardo García-Díaz1, Juan Carlos de Agustín2, Antonio Ontanilla3, Maria Luisa Marenco5, Antonio Pavón4, Antonio Losada4 and Guillermo Antiñolo16*

Author Affiliations

1 Unidad de Gestión Clínica de Genética, Reproducción y Medicina Fetal. Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41003 Sevilla, Spain

2 Unidad de Gestión Clínica de Cirugía Infantil, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain

3 Servicio de Anestesiología Hospital Infantil, Hospitales Universitarios Virgen Del Rocío, 41013 Sevilla, Spain

4 Unidad De Gestión Clínica De Neonatología, Hospital Universitario Virgen Del Rocío, 41013 Sevilla, Spain

5 Servicio de Anestesiología Hospital de La Mujer, Hospital Universitario Virgen Del Rocío, 41013 Sevilla, Spain

6 Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Sevilla, Spain

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BMC Pregnancy and Childbirth 2014, 14:252  doi:10.1186/1471-2393-14-252

Published: 30 July 2014

Abstract

Background

Indications for the ex utero intrapartum therapy (EXIT) procedure have evolved and nowadays in addition to secure the airway, obtain vascular access, administer surfactant and other resuscitation medications, EXIT is used to resect cervical or thoracic masses, for extracorporeal membrane circulation (ECMO) cannulation, as well as to rescue maximum intra-thoracic space for ventilation of the remaining functional lung tissue or in cases in which resuscitation of the neonate may be compromised. EXIT procedure in twin pregnancy has been rarely reported and some doubts have been raised about its strategy and safety in such cases.

Methods

We reviewed the medical records of 3 twin pregnancy cases where the EXIT procedure have been performed in our center.

Results

The mean gestational age at EXIT procedure was 34 + 4 weeks. In two out the three EXIT procedures, the affected twin was delivered first. The average time on placental bypass was 9 minutes. There were no fetal or maternal complications related to the EXIT procedure. All newborns are currently doing well.

Conclusion

In twin pregnancies, prenatal diagnosis combined with the EXIT procedure permits the formulation of a controlled delivery strategy to secure both newborns outcome. In those pregnancies, if intervention can be accomplished without compromise of the normal twin, EXIT can be considered. Our results support that EXIT procedure, if properly planned, safely provides a good outcome for both the fetuses as well as the mother.

Keywords:
Prenatal diagnosis; Fetal medicine; Fetal intervention; Twin pregnancy; Ex utero intrapartum therapy (EXIT) procedure