Acronym for Congenital High Airway Obstruction Syndrome.

Prenatal diagnosis of a major obstruction of the upper airway, due to a pathology of the larynx or trachea (cyst, atresia, stenosis, webbing). Ultrasound examination shows the presence of large echogenic lungs, dilated distal airways, flat diaphragmatic cupolas and the presence of ascites (hydrops). The presence of a polyhydramnios is an additional sign of gravity.

Anesthetic implications: 

the delivery  of the child has to be planned under materno-fetal circulation until the baby airway control is secured  (intubation, tracheotomy).

There are two types of procedures:

-        EXIT (acronym for EX utero Intrapartum Treatment): only the head and one or two upper limbs of the fetus are taken out of the uterine cavity. So doing, a certain uterine distension is maintained and permits a persistent materno-fetal circulation: extraction of the child and clamping of the umbilical cord are postponed until the procedure is completed or the occurrence of an unexpected maternal complication

-        OOPS (acronym for Operation On Placental Support): the entire body of the newborn is taken out the uterine cavity but the cord is not clamped immediately. This usually provides 10 -20 minutes of time on placental circulation.

References : 

-         Laje P, Johnson MP, Howell LJ et al. 
Ex utero intrapartum treatment in the management of giant cervical teratomas. 
J Pediatr Surg 2012; 47: 1208-16.

-         Zadra N, Giusti F. 
Ex utero intrapartum surgery (EXIT): indications and anaesthetic management. 
Best Pract Res Clin Anaesthesiol 2004; 18: 259-71.

-         Ducloy-Bouthors A-S, Marciniak B, Vaast P, Fayoux P, Houfflin-Debarge V, Fily A, Rakza T. 
Anesthésie maternofoetale pour “ex utero intrapartum” traitement (EXIT) procédure: à propos de deux cas. 
Ann Fr Anesth Réanim 2006; 25:638-43.

-         George RB, Melnick AH, Rose EC, Habib AS. 
Case series : combined spinal epidural anesthesia for Cesarian delivery and ex utero intrapartum treatment procedure.
Can J Anesth 2007; 54:218-22.

-         Eschertzhuber S, Keller C, Mitterschiffthaler G, Jochberger S, Kühbacher G. 
Verifying correct endotracheal intubation by measurement of end-tidal carbon dioxide during an ex utero intrapartum treatment procedure. 
Anesth Analg 2005; 101:658-60.

Updated: October 2019