Advanced foetal surgery saved the life of the child

News

With short notice, in the midst of a pandemic, a large multidisciplinary team of specialists was brought together to perform advanced foetal surgery. The so-called EXIT procedure is an unusual intervention, and is used when a foetus has large tumours in the head or neck.

The EXIT procedure is a very complicated operation, requiring an experienced and well-trained multidisciplinary team comprising specialists in foetal medicine, ENT surgery, anaesthesiology, neonatology and paediatric surgery.

The operation is a life-saving procedure for foetuses with congenital airway compression or large head or neck tumours. The pregnant woman is given a general anaesthetic. The baby is partially delivered to expose the head and upper part of the thorax in order to create a free airway. The purpose of the procedure is that the foetus will continue to receive oxygen via the placenta, thereby giving the surgeons enough time to create a free airway without risking brain damage or death.

This EXIT procedure was performed in the 31st week of the pregnancy. The process was organised extremely quickly – the operation was performed just four weeks after the tumour had been discovered.

"We are very pleased that the collaboration within our multidisciplinary team worked so well, despite the current situation with the ongoing pandemic. The procedure went really well, and the child's neck tumour was also successfully removed", say Eleonor Tiblad and Peter Conner, who are senior physicians with medical responsibility for foetal surgery and foetal care at Karolinska.

Facts

EXIT is an uncommon but life-saving intervention used in the event of congenital obstacles in the upper airway and neck/head tumours that cause a blocked airway in a foetus.

On average, EXIT deliveries are performed in the 34th week of pregnancy.
Around 1-2 such operations are performed in Sweden every year.

EXIT deliveries are performed by multidisciplinary teams of foetal specialists, ENT surgeons, neonatologists and anaesthesiologists.

Karolinska University Hospital has the longest experience of this procedure in all the Nordic countries.

Since 1 May 2020, Karolinska has been the sole practitioner in Sweden with sole authorisation for national highly specialised care for the performance of EXIT procedures.