To sustain life! Xiangya Third Hospital successfully completed 2 cases of extrauterine intrapartum treatment (EXIT)

Recently, the Department of Prenatal Diagnosis/Fetal Medicine of the Department of Obstetrics and Gynecology, the Department of Pediatric Surgery, the Department of Neonatology, and the Department of Anesthesiology of the Third Xiangya Hospital of Central South University worked together to successfully complete the extrauterine treatment (EXIT) of two fetuses with congenital abnormalities on October 21 and November 1, respectively .

Among them, the fetus with congenital left diaphragmatic hernia was discovered by the pregnant woman at the Third Xiangya Hospital on August 19, when she was 26 weeks and 5 days pregnant. After receiving the diagnosis, Director Mi Chunmei of the obstetrics department conducted a detailed examination for the parturient, and after amniocentesis prenatal diagnosis ruled out chromosomal and genetic abnormalities, the parturient decided to keep the fetus.

Because "congenital diaphragmatic hernia is a serious congenital malformation in which the fetal abdominal organs herniate into the chest cavity due to incomplete development of the diaphragm during embryonic development. The incidence rate is about 2.6/10000. After birth, the children are prone to poor development due to lung compression, leading to respiratory distress, and then persistent pulmonary hypertension and heart failure, and severe cases can cause death." Mi Chunmei decided to use the EXIT surgery, but because this procedure requires a highly skilled multidisciplinary team of highly collaborative and meticulous cooperation, Mi Chunmei quickly organized a multidisciplinary consultation and jointly formulated a strict surgical timing and plan.

On November 1, the pregnant woman underwent a cesarean section at 37 weeks of pregnancy, and the baby was also given an exit during the operation. The operation went smoothly, and the woman was discharged from the hospital on November 4.

The second child who underwent the EXIT procedure had his mother discovered through color ultrasound on September 4, when she was 26 weeks and 4 days pregnant, that one of the twin fetuses had gastroschisis and exposed intestines.

Under the guidance of Dr. Cheng Chunxia, ​​chief physician of the obstetrics department, the pregnant woman did not choose fetal reduction but continued her pregnancy after prenatal diagnosis ruled out chromosomal and genetic abnormalities.

Cheng Chunxia introduced: "Gastroschisis is a deformity caused by the full-thickness defect of the abdominal wall near the umbilicus, which leads to the prolapse of internal organs. The incidence rate is 1/3000~1/5000, and it is more common in male babies than female babies, with a ratio of 2:1." And "postpartum surgery is the only treatment method. If the surgery is not performed in time, it will cause adverse consequences such as intestinal rupture and necrosis, abdominal infection, intestinal obstruction, and severe cases can lead to death," Cheng Chunxia continued to emphasize.

Therefore, in order to ensure the safety of the newborn, on October 21, the multidisciplinary team of Xiangya Third Hospital urgently performed a cesarean section for the parturient at "more than 34 weeks of pregnancy, breech presentation, and premature labor", and performed EXIT for the child during the operation. The operation was successfully completed and the parturient was discharged from the hospital on October 25.

In order to provide the most effective and timely treatment for the children, Xiangya Third Hospital also worked with Director Zhou Chonggao of the Department of Neonatal Surgery at Hunan Children's Hospital and his team to welcome the birth of these two "special" little angels in the operating room. With the assistance and cooperation of multiple disciplines, both cases of extrauterine treatment were successfully completed, and the vital signs of the children were stable.

It is understood that EXIT is an emerging technology with great development potential in fetal surgical treatment. Compared with traditional neonatal surgery, the baby is operated on immediately after coming out of the uterus, and an artificial airway is established before the fetus is separated from the placental circulation to reduce the risk of hypoxia. The operation is performed before the gastrointestinal tract of the newborn is inflated, which can better control the pressure in the chest and abdominal cavity, facilitate the success of abdominal wall defect repair and diaphragmatic hernia repair, and reduce the chance of infection.

In recent years, the application scope of EXIT has gradually expanded. This technology can be used to detect prenatally that the fetus may have airway compression and unstable cardiopulmonary function at birth, including huge neck masses, oropharyngeal masses, severe micrognathia, huge lung and mediastinal lesions, etc. It can significantly improve the prognosis of the newborn and is of great significance to reducing the perinatal mortality of children with birth defects.

With the progress and development of medicine, more and more congenital abnormalities can be diagnosed prenatally. At the same time, the development of fetal medicine continues to improve, bringing new possibilities for the continuation of life. In the future, the Department of Obstetrics of the Third Xiangya Hospital of Central South University will continue to escort mothers and newborns.

Hunan Medical Chat Special Author: Cheng Chunxia and Tang Qin, Department of Obstetrics, Xiangya Third Hospital, Central South University

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(Edited by YT)