Background: The Ex-utero Intrapartum Treatment (EXIT) is a procedure developed to manage a range of fetal conditions, aiming to ensure the maintenance of neonatal airway and preserving the feto-placental circulation. Its goal is to enhance the neonatal ability to successfully transition and adapt to postnatal life, thereby reducing perinatal morbidity and mortality. However, EXIT has been associated with a high risk of maternal complications. This paper provides an overview of the indications and characteristics of the EXIT procedure, as well as the obstetric outcomes and maternal complications. Methods: A retrospective analysis was conducted on a cohort of patients undergoing EXIT at our center between January 2007 and December 2022. Maternal outcomes, including demographic information, data related to the surgical procedure, surgical complications, and postoperative complications were analyzed. To assess the severity of the surgical complications, a modified Clavien-Dindo classification was used. Comparative analysis was performed by randomly selecting a sample from elective cesarean deliveries performed at our center. Results: A total of 34 EXIT procedures were performed. According to the modified Clavien-Dindo classification, we observed no major complications, while minor maternal complications were present in 2.94% of cases. Compared to elective cesarean deliveries (n = 350), there were no significant differences in terms of maternal complications, highlighting the similarity observed in the mean decrease in postoperative hemoglobin (1.15 g/dL in EXIT vs. 1.2 g/dL in elective cesarean deliveries, p = 0.94). In EXIT group, there was a higher rate of polyhydramnios (26.47% vs 6.59%, p < 0.001), as well as the need for amnioreduction (14.71% vs 0%, p = 0.001) and preterm delivery (32.35% vs 6.02%, p = 0.001). There were no cases of endometritis, post-procedural fever, or abruptio placentae following EXIT. Conclusions: EXIT can be considered a safe procedure when performed under adequate conditions, including appropriate uterine access and proper anesthetic management. In our series, EXIT procedure was not associated with a higher incidence of maternal complications when compared to elective cesarean delivery. Trial registration: Retrospectively registered.

Objective: To derive pooled estimates of maternal, fetal and pediatric outcomes up to the age of 30 months in patients undergoing pre‐ or postnatal surgery for open spina bifida (OSB). Methods: A systematic search was conducted in MEDLINE, PubMed (non‐MEDLINE records), Embase, Web of Science, ClinicalTrials.gov , Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, as well as ‘gray’ literature, for studies reporting on maternal, fetal and/or pediatric outcomes related to pre‐ or postnatal surgery for OSB. Only studies with inclusion criteria similar to those of the Management of Myelomeningocele Study were included. Study quality and risk of bias were assessed. Meta‐analysis of single proportions was performed. Results: No case of maternal death was reported following prenatal surgery for OSB. Common maternal complications among those who underwent prenatal surgery included preterm prelabor rupture of membranes (open classical hysterotomy, 31%; open minihysterotomy, 33%; hybrid fetoscopy, 32%; percutaneous fetoscopy, 80%) and preterm birth before 32 weeks' gestation (open classical hysterotomy, 12%; open minihysterotomy, 15%; hybrid fetoscopy, 13%; percutaneous fetoscopy, 33%). Among patients who underwent open classical hysterotomy for OSB and later became pregnant again, 4% and 9% experienced placenta accreta spectrum disorder and uterine rupture, respectively, in any subsequent pregnancy. The most common neonatal complications were respiratory distress syndrome, apnea and postnatal surgical wound revision. Perinatal and infant death rates were similar regardless of whether the surgery was performed pre‐ or postnatally. The rate of cerebrospinal fluid diversion surgery at 12 months after birth was lower following prenatal surgery (open classical hysterotomy, 38%; open minihysterotomy, 17%; hybrid fetoscopy, 36%; percutaneous fetoscopy, 46%) compared with postnatal surgery (81%). The proportion of toddlers walking with or without assistive devices at 30 months after birth was higher in some prenatal surgery groups (open classical hysterotomy, 72%; open minihysterotomy, 66%; percutaneous fetoscopy, 81%) compared with the postnatal repair group (57%). The rate of clean intermittent catheterization for bladder management at 30 months after birth was 39% in the open classical hysterotomy group and 41% in the percutaneous fetoscopy group, compared with 53% in the postnatal surgery group. Each surgical approach was associated with a specific constellation of procedure‐related complications. Conclusions: We provide pooled estimates for maternal, fetal and pediatric outcomes for all currently used perinatal surgical approaches for OSB repair, each of which has its specific advantages and disadvantages. Our data should serve to inform clinical decision analysis to identify the best surgical approach for OSB cases. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The Ex Utero Intrapartum Treatment (EXIT) procedure has long been an invaluable tool in managing complex fetal conditions requiring airway interventions during the transition from intrauterine to extrauterine life. This technical note offers an in-depth examination of the EXIT procedure, emphasizing the refinements and innovations introduced at our center. The technique focuses on meticulous preoperative assessment and uses distinctive techniques and anesthetic methodologies. A multidisciplinary team assembles to plan the EXIT procedure, emphasizing patient communication and risk discussion. Our technique involves atraumatic access to the uterine cavity, achieved through the application of a uterine progressive distractor developed for this purpose. Following the use of this distractor, vascular clamps and a stapling device (Premium Poly Cs-57 Autosuture^®, Medtronic) are employed. Our anesthetic approach employs general anesthesia with epidural catheter placement. Maternal operation involves low transverse laparotomy and intraoperative ultrasonography-guided hysterotomy. Fetal exposure includes gentle extraction or external version, ensuring airway access. After securing fetal airway access, umbilical cord clamping and maternal abdominal closure conclude the procedure. By revisiting the core principles of EXIT and incorporating center-specific advancements, we enhance our understanding and technical expertise. To our knowledge, this is the first time a detailed description of the technique has been published.

Introduction Despite advances in neonatal intensive care, fetuses with congenital diaphragmatic hernia (CDH) remain to have a poor prognosis. Exclusive postnatal treatment is inadequate in patients with moderate CDH (observed than expected lung-to-head ratio [O/E LHR] 26–45%) and can lead to respiratory failure at birth, requiring extracorporeal membrane oxygenation in 75% of cases. An ex-utero intrapartum treatment (EXIT) procedure may be beneficial in these cases, improving the fetal-neonatal transition. Material and Methods We review all pregnancies with fetal isolated left CDH with moderate O/E LHR delivered by EXIT in our center from January 2007 to December 2022. Maternal and neonatal variables were analyzed. As primary outcomes, we included neonatal survival and mortality rates, surgical and infectious complications, uterine scar dehiscence, and blood loss during EXIT. As secondary outcomes, we studied recurrences of the diaphragmatic defect, long-term evolution, subsequent pregnancies, and mode of delivery. Results A total of 14 patients were delivered by the EXIT procedure, with a neonatal survival rate of 85.7%. All these children had optimal physical and neurocognitive development and no pulmonary morbidity. We found no major complications and 7.1% of minor maternal complications. There were no cases of surgical wound infection or endometritis. The median decrease in hemoglobin during the EXIT procedure was 1.9 mg/dL, and only one case required postoperative transfusion. Two out of the 14 women became pregnant again, and both pregnancies were uneventful. Conclusions In our series, the EXIT procedure allows for adequate airway management associated with a high neonatal survival rate in patients with moderate O/E LHR CDH, with a low rate of neonatal and maternal complications.

Blunt abdominal trauma in pregnant woman complicated by intestinal ischaemia: A case reportRunning title: A case of intestinal ischaemia after blunt abdominal trauma in pregnancy

Background: Blunt abdominal trauma in pregnancy is a medical emergency with significant maternal-fetal morbidity and mortality. Although rare, intestinal ischemia can occur as a serious abdominal complication following trauma during pregnancy. Case presentation: A 41-year-old woman at 33 weeks and 6 days of gestation was involved in a car accident, as a passenger in the front seat of a vehicle that left the road and overturned. The initial examination revealed severe chest trauma but no immediate signs of abdominal injury. However, the patient's condition worsened, showing delayed symptoms of gastrointestinal dysfunction, clinical deterioration, and labor onset. Complementary imaging studies did not reveal conclusive findings suggesting complications related to the blunt abdominal trauma. Following a multidisciplinary team's decision to perform an emergency cesarean section in the maternal-fetal interest, intestinal ischemia secondary to a mesenteric tear was discovered, necessitating intestinal resection and end-to-end anastomosis. Conclusions: Despite being a rare condition often associated with diagnostic delays, in cases of sudden clinical deterioration or maternal hemodynamic instability, immediate multidisciplinary intervention is essential. This approach may allow the early detection of trauma-related complications, reducing potentially preventable deaths and achieving favorable maternal and neonatal outcomes.