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Federación Mexicana de Ginecología y Obstetricia, A.C.

2019, Número 11

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Ginecol Obstet Mex 2019; 87 (11)


EXIT (Ex-Utero Intrapartum Treatment) como opción de tratamiento en fetos con alto riesgo de muerte. Revisión sistemática de la bibliografía

Novoa RH, Quintana W, Ventura W

Idioma: Español
Referencias bibliográficas: 83
Paginas: 769-780
Archivo PDF: 401.89 Kb.


RESUMEN

Objetivos: Describir las características de las pacientes, la técnica quirúrgica y las complicaciones maternas y fetales de la cirugía EXIT (Ex-Utero Intrapartum Treatment) que no incluyan tumoraciones orales ni cervicales.
Metodología: Búsqueda de artículos en MEDLINE, EMBASE, Cochrane Library y LILACS hasta septiembre 2018 de todos los reportes o series de casos de aplicación de cirugía EXIT. Dos autores llevaron a cabo la selección, evaluación y extracción de datos y, posteriormente, se efectuó el análisis descriptivo.
Resultados: Se incluyeron 71 artículos identificados a texto completo que incluyeron 242 casos de cirugía EXIT. La indicación más frecuente en fetos fue la hernia diafragmática (92%). La cirugía EXIT se practicó, en promedio, a las 34.4 semanas de gestación. El acceso para asegurar la vía aérea fetal fue, en 77% de los casos, mediante intubación orotraqueal. No se reportaron muertes maternas y la supervivencia perinatal global fue de 77%.
Conclusiones: La cirugía EXIT es un procedimiento seguro para el feto y para la madre y tiene distintas indicaciones; la más frecuente es el retiro de balón endotraqueal en el tratamiento de la hernia diafragmática.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Cruz-Martínez R, y col. Técnica EXIT (Ex Utero Intrapartum Treatment): indicaciones, limitaciones, riesgos y evolución a la técnica de intubación traqueal fetal endoscópica (FETI). Ginecol Obstet Mex. 2015;83(1).

  2. Bouchard S, et al. The EXIT procedure: experience and outcome in 31 cases. J Pediatr Surg. 2002;37(3):418-26. https://doi.org/10.1053/jpsu.2002.30839

  3. Moldenhauer JS. Ex Utero Intrapartum Therapy. Seminars in pediatric surgery. 2013;22(1):44-9.

  4. Abraham RJ, et al. A review of the EXIT (ex utero intrapartum treatment) procedure. Journal of obstetrics and gynaecology : Journal Obstetrics and Gynaecology. 2010; 30 (1): 1-5. https://doi.org/10.3109/01443610903281656

  5. Harrison MR, et al. Correction of congenital diaphragmatic hernia in utero VIII: Response of the hypoplastic lung to tracheal occlusion. J Pediatr Surg. 1996; 31 (10): 1339-48. https://doi.org/10.1016/S0022-3468(96)90824-6

  6. Taghavi K, Beasley S. The ex utero intrapartum treatment (EXIT) procedure: application of a new therapeutic paradigm. Journal of Paediatrics and Child Health. 2013; 49 (9): E420-7. https://doi.org/10.1111/jpc.12223

  7. Laveriano WV, et al. Intubación endotraqueal intraparto en un feto con hernia diafragmática. A propósito de la primera cirugía fetal EXIT (ex-utero intrapartum treatment) en el Perú. Revista Peruana de Ginecología y Obstetricia. 2016; 61 (4): 417-21.

  8. Gaiser RR, et al. Anesthetic management of cesarean delivery complicated by ex utero intrapartum treatment of the fetus. Anesthesia and Analgesia. 1997;84(5):1150-3.

  9. Mychaliska GB, et al. Operating on placental support: the ex utero intrapartum treatment procedure. J Pediatr Surg. 1997; 32 (2): 227-31. https://doi.org/10.1016/S0022- 3468(97)90184-6

  10. DeCou JM, et al. Successful ex utero intrapartum treatment (EXIT) procedure for congenital high airway obstruction syndrome (CHAOS) owing to laryngeal atresia. J Pediatr Surg. 1998; 33 (10): 1563-5. https://doi.org/10.1016/ S0022-3468(98)90500-0

  11. Bui TH, et al. Successful EXIT (ex utero intrapartum treatment) procedure in a fetus diagnosed prenatally with congenital high-airway obstruction syndrome due to laryngeal atresia. Eur J Pediatr Surg. 2000; 10 (5): 328-33. doi: 10.1055/s-2008-1072385

  12. Crombleholme TM, et al. Salvage of a fetus with congenital high airway obstruction syndrome by ex utero intrapartum treatment (EXIT) procedure. Fetal Diagnosis and Therapy. 2000; 15 (5): 280-2. https://doi.org/10.1159/000021022

  13. Prontera W, et al Ex utero intrapartum treatment (EXIT) of severe fetal hydrothorax. Archives of disease in childhood Fetal and neonatal edition. ADC Fetal and Neonatal. 2002;86(1):F58-60. http://dx.doi.org/10.1136/ fn.86.1.F58

  14. Russell MW, Gomez C, Nugent C, Christiansen J. Large fetal pulmonary arteriovenous fistula: impact on pulmonary development. J Pediatric Cardiology. 2002;23(4):454-7. https://doi.org/10.1007/s00246-002-0127-2

  15. Hedrick HL. Ex utero intrapartum therapy. Seminars in Pediatric Surgery. 2003; 12 (3): 190-5. https://doi. org/10.1016/S1055-8586(03)00026-X

  16. Lim FY, et al. Congenital high airway obstruction syndrome: natural history and management. J Pediatr Surg. 2003; 38 (6): 940-5. https://doi.org/10.1016/S0022-3468(03)00128- 3

  17. Oepkes D, et al. Congenital high airway obstruction syndrome successfully managed with ex-utero intrapartum treatment. Ultrasound Obstet Gynecol. 2003;22(4):437-9. https://doi.org/10.1002/uog.899

  18. Rosen MA, et al. Nitroglycerin for fetal surgery: fetoscopy and ex utero intrapartum treatment procedure with malignant hyperthermia precautions. Anesthesia & Analgesia. 2003;96(3):698-700. doi: 10.1213/01. ANE.0000049686.20464.3B

  19. Baker PA, et al. Airway management during an EXIT procedure for a fetus with dysgnathia complex. Paediatric Anaesthesia. 2004;14(9):781-6. https://doi.org/10.1111/ j.1460-9592.2004.01284.x

  20. Dahlgren G, et al. Four cases of the ex utero intrapartum treatment (EXIT) procedure: anesthetic implications. Int J Obstet Anesth. 2004;13(3):178-82. https://doi. org/10.1016/j.ijoa.2004.01.007

  21. Hirose S, et al. The ex utero intrapartum treatment procedure: Looking back at the EXIT. J Pediatr Surg. 2004;39(3):375-80. https://doi.org/10.1016/j.jpedsurg. 2003.11.011

  22. 22. Kanamori Y, et al. A case of laryngeal atresia (congenital high airway obstruction syndrome) with chromosome 5p deletion syndrome rescued by ex utero intrapartum treatment. J Pediatr Surg. 2004; 39 (1): E25-8. https://doi. org/10.1016/j.jpedsurg.2003.09.041

  23. Parry AJ, et al. Median sternotomy as an exit procedure in a child with massive pericardial tumor. J Pediatr Surg. 2004; 39 (9): 1408-10. https://doi.org/10.1016/j.jpedsurg. 2004.05.025

  24. Chang YL, et al . Congenital chylothorax in three siblings. AJOG. 2005;192(6):2065-6. https://doi.org/10.1016/j. ajog.2004.09.012

  25. Chu GM, et al. Ex-utero intrapartum treatment: a controlled approach to the management of anticipated airway problems in the newborn. Hong Kong Med J 2006; 12 (5): 381-4.

  26. Kohl T, et al. Fetoscopic and ultrasound-guided decompression of the fetal trachea in a human fetus with Fraser syndrome and congenital high airway obstruction syndrome (CHAOS) from laryngeal atresia. Ultrasound in obstetrics & Gynecology. 2006;27(1):84-8. https://doi. org/10.1002/uog.1974

  27. Otteson TD, et al. The Ex Utero Intrapartum Treatment (EXIT) procedure: new challenges. Arch Otolaryngol Head Neck Surg. 2006;132(6):686-689. doi:10.1001/archotol. 132.6.686

  28. Colnaghi M, et al. Prenatal diagnosis and postnatal management of congenital laryngeal atresia in a preterm infant. Ultrasound Obstet Gynecol. 2007; 29 (5): 583-5. https:// doi.org/10.1002/uog.3978

  29. George RB, et al. Case series: Combined spinal epidural anesthesia for Cesarean delivery and ex utero intrapartum treatment procedure. Can J Anesth 2007; 54 (3): 218-22. https://doi.org/10.1007/BF03022643

  30. Kern C, et al. Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies. Swiss Medical Weekly. 2007; 137 (19-20): 279-85.

  31. Kunisaki SM, et al. Ex utero intrapartum treatment with extracorporeal membrane oxygenation for severe congenital diaphragmatic hernia. J Pediatr Surg. 2007;42(1):98-106. https://doi.org/10.1016/j.jpedsurg.2006.09.009

  32. Saura L, et al. Impact of fetal intervention on postnatal management of congenital diaphragmatic hernia. Eur J Pediatr Surg. 2007;17(6):404-7. doi: 10.1055/s-2007- 989275

  33. Shimabukuro F, et al. A case of congenital high airway obstruction syndrome managed by ex utero intrapartum treatment: case report and review of the literature. Amer J Perinatol. 2007; 24 (3): 197-201. doi: 10.1055/s-2007- 972928

  34. Steiner H, et al. Ex-Utero Intrapartum Treatment (EXIT) in a giant case of Congenital Cystic Adenomatoid Malformation (CCAM) of the lung. Ultraschall in der Med. 2007; 28 (6): 626-28.doi: 10.1055/s-2007-963347

  35. Umekawa T, et al. A case of agnathia-otocephaly complex assessed prenatally for ex utero intrapartum treatment (EXIT) by three-dimensional ultrasonography. Prenatal Diagnosis. 2007;27(7):679-81. https://doi.org/10.1002/ pd.1754

  36. Benonis JG, Habib AS. Ex utero intrapartum treatment procedure in a patient with arthrogryposis multiplex congenita, using continuous spinal anesthesia and intravenous nitroglycerin for uterine relaxation. Int J Obstet Anesth. 2008;17(1):53-6. https://doi.org/10.1016/j. ijoa.2007.01.007

  37. Chang LC, Kuczkowski KM. The ex utero intrapartum treatment procedure: anesthetic considerations. Archives of gynecology and obstetrics. 2008;277(1):83-5. https:// doi.org/10.1007/s00404-007-0402-9

  38. Guimaraes CV, et al. Prenatal MRI findings of fetuses with congenital high airway obstruction sequence. Korean Journal of Radiology. 2009; 10 (2): 129-34. https://doi. org/10.3348/kjr.2009.10.2.129

  39. Henry PY, et al. Extrauterine Intrapartum Treatment (EXIT) in bilateral primary fetal hydrothorax. Indian journal of pediatrics. 2009;76(1):99-101. https://doi.org/10.1007/ s12098-009-0038-9

  40. Kohl T, et al. Percutaneous fetoscopic laser decompression of congenital high airway obstruction syndrome (CHAOS) from laryngeal atresia via a single trocar--current technical constraints and potential solutions for future interventions. Fetal Diagnosis and Therapy. 2009;25(1):67-71. https://doi. org/10.1159/000200017

  41. Morris LM, Lim FY, Crombleholme TM. Ex utero intrapartum treatment procedure: a peripartum management strategy in particularly challenging cases. J Pediatrics. 2009; 154 1): 126-31.e3. https://doi.org/10.1016/j.jpeds.2008.09.044

  42. Morris LM, et al. Severe micrognathia: indications for EXIT-to-Airway. Fetal Diagn Ther. 2009;26(3):162-6. doi: 10.1159/000240162)

  43. Mychaliska GB, et al. Giant pulmonary sequestration: the rare case requiring the EXIT procedure with resection and ECMO. Fetal Diagnosis and Therapy. 2009; 25 (1): 163-6. https://doi.org/10.1159/000209202

  44. Vaikunth SS, et al. Congenital high airway obstruction syndrome due to complete tracheal agenesis: an accident of nature with clues for tracheal development and lessons in management. Fetal Diagnosis and Therapy. 2009;26(2):93- 7. https://doi.org/10.1159/000242454

  45. Antinolo G, et al. Diagnosis and management of fetal intrapericardial Morgagni diaphragmatic hernia with massive pericardial effussion. J Pediatr Surg. 2010; 45 (2): 424-6. https://doi.org/10.1016/j.jpedsurg.2009.11.009

  46. Berrington JE, et al. Emergency EXIT for preterm labour after FETO. Archives of Disease in Childhood Fetal and Neonatal edition. 2010;95(5):F376-7. http://dx.doi. org/10.1136/adc.2009.177303

  47. Botto HA, Boailchuk. Tratamiento extrauterino intraparto: manejo del recién nacido con síndrome de obstrucción congénita de la vía aérea superior: informe de un caso. Arch Argent Pediatr. 2010;108(4):e92-e5.

  48. Fink RJ, et al. Remifentanil for fetal immobilization and analgesia during the ex utero intrapartum treatment procedure under combined spinal-epidural anaesthesia. BJA. 2011; 106 (6): 851-5. https://doi.org/10.1093/bja/aer097

  49. Hamid-Sowinska A, et al. Congenital high airway obstruction syndrome. Neuro Endocrinology Letters. 2011; 32 (5): 623-6.

  50. Ioscovich A, et al. Remifentanil-nitroglycerin combination as an anesthetic support for ex utero intrapartum treatment (EXIT) procedure. J clinical anesthesia. 2011;23(2):142-4. https://doi.org/10.1016/j.jclinane.2009.12.014

  51. Lazar DA, et al. Fetal lung interstitial tumor: a cause of late gestation fetal hydrops. J Pediatr Surg. 2011; 46 (6): 1263-6. https://doi.org/10.1016/j.jpedsurg.2011.02.056

  52. Miwa I, et al. Congenital high airway obstruction syndrome in the breech presentation managed by ex utero intrapartum treatment procedure after intraoperative external cephalic version. J Obstet Gynaecol Research. 2012; 38 (5): 854-7. https://doi.org/10.1111/j.1447-0756.2011.01801.x

  53. Ruano R, et al. A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia. Ultrasound in Obstetrics & Gynecology. 2012;39(1):20-7. https://doi.org/10.1002/uog.10142

  54. Saadai P, et al. Long-term outcomes after fetal therapy for congenital high airway obstructive syndrome. J Pediatr Surg. 2012;47(6):1095-100. https://doi.org/10.1016/j. jpedsurg.2012.03.015

  55. Stoffan AP, et al. Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change outcomes for high-risk patients with congenital diaphragmatic hernia? J Pediatr Surg. 2012; 47 (6): 1053-7. https://doi.org/10.1016/j.jpedsurg.2012.03.004

  56. Cass DL, et al. EXIT-to-resection for fetuses with large lung masses and persistent mediastinal compression near birth. J Pediatr Surg. 2013; 48 (1): 138-44. https://doi. org/10.1016/j.jpedsurg.2012.10.067

  57. Coleman AM, et al. Tracheal agenesis with tracheoesophageal fistulae: fetal MRI diagnosis with confirmation by ultrasound during an ex utero intrapartum therapy (EXIT) delivery and postdelivery MRI. Pediatric Radiology. 2013; 43 (10): 1385-90. https://doi.org/10.1007/s00247- 013-2679-0.

  58. Osborn AJ, et al. Multidisciplinary perinatal management of the compromised airway on placental support: lessons learned. Prenatal Diagnosis. 2013; 33 (11): 1080-7. https:// doi.org/10.1002/pd.4200

  59. Calvo-Garcia MA, et al. Congenital peribronchial myofibroblastic tumor: prenatal imaging clues to differentiate from other fetal chest lesions. Pediatric Radiology. 2014; 44 (4): 479-83. https://doi.org/10.1007/s00247-013-2817-8

  60. Chatterjee D, et al. Ex utero intrapartum treatment to resection of a bronchogenic cyst causing airway compression. Fetal Diagnosis and Therapy. 2014; 35 (2): 137-40. https:// doi.org/10.1159/000355661

  61. DaValle B, et al. Ex utero intrapartum treatment of fetal micrognathia. Military Medicine. 2014; 179 (6): e705-11. https://doi.org/10.7205/MILMED-D-13-00466

  62. Ogasawara K, et al. Ex utero intrapartum treatment for an infant with cerebro-costo-mandibular syndrome. Pediatrics International. 2014; 56 (4): 613-5. https://doi.org/10.1111/ ped.12299

  63. Pivetti V, et al. Cesarean section plus delayed cord clamping approach in the perinatal management of congenital high airway obstruction syndrome (CHAOS): a case report. Journal of Neonatal-Perinatal Medicine. 2014; 7 (3): 237-9. doi: 10.3233/NPM-14814006

  64. Suenaga M, et al. Successful ex utero intrapartum treatment procedure for prenatally diagnosed severe micrognathia: a case report. Obstetrics & Gynecology. 2014; 40 (8): 2005-9. https://doi.org/10.1111/jog.12423

  65. 6Basta MN, et al. Total Airway Reconstruction in the Neonate: Combined Mandibular Distraction and Slide Tracheoplasty for Multiple Level Airway Obstruction. Journal of Craniofacial Surgery. 2015; 26 (8): e788-91. doi: 10.1097/ SCS.0000000000002145

  66. Peng E, et al Ex-utero intrapartum treatment as a novel bridging strategy to surgery in hypoplastic left heart syndrome with intact atrial septum-cross-circulation revisited. JTCVS. 2015; 149 (3): 935-7. https://doi.org/10.1016/j. jtcvs.2014.11.053

  67. Braden A, et al. Anesthetic management of an ex utero intrapartum treatment procedure: a novel balanced approach. J Clin Anesth. 2016; 31: 60-3. https://doi. org/10.1016/j.jclinane.2015.12.010

  68. Kanasugi T, et al. Successful ultrasound-guided intraoperative external cephalic version of fetus in breech presentation immediately before ex-utero intrapartum treatment (EXIT) procedure. Ultrasound in Obstetrics & Gynecology. 2016;47(5):653-5. https://doi.org/10.1002/uog.15763

  69. Lin EE, et al. Anesthetic Management of 65 Cases of Ex Utero Intrapartum Therapy: A 13-Year Single-Center Experience. Anesthesia & Analgesia. 2016; 123 (2): 411-7. https://doi.org/10.1213/ANE.0000000000001385

  70. Rychik J, et al. Fetal intrapericardial teratoma: natural history and management including successful in utero surgery. AJOG. 2016; 215 (6): 780.e1-.e7. https://doi.org/10.1016/j. ajog.2016.08.010

  71. Cuneo BF, et al. Ex utero Intrapartum Treatment to Ventricular Pacing: A Novel Delivery Strategy for Complete Atrioventricular Block with Severe Bradycardia. Fetal Diagn Ther. 2017; 42: 311-14. https://doi.org/10.1159/000475815

  72. Hung TH, et al. Ex utero intrapartum treatment for extremely low birth-weight neonates requiring resuscitation at birth. Taiwan J Obstet Gynecol 2017; 56 (4): 561-3. doi: 10.1016/j.tjog.2017.07.001.

  73. Koch S, et al. [EXIT - A Possible Intervention for New- and Earlyborn Babies with Severe Hydrops Fetalis and Hydrothoraces on Both Sides]. Zeitschrift fur Geburtshilfe und Neonatologie. 2017. 10.1055/s-0043-117419

  74. Stoffan AP, et al. Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change morbidity outcomes for high-risk congenital diaphragmatic hernia survivors? J Pediatr Surg. 2012; 47: 1053-57. https://doi.org/10.1016/j.jpedsurg.2012.03.004

  75. Zhuang J, et al. Ex utero Intrapartum Treatment for the Pericardial Effusion Drain of a Fetal Cardiac Tumor. Chin Med J (Engl). 2017;130 (11): 1381-2. 10.4103/0366-6999.206342

  76. Kunisaki SM, et al. Ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation for fetal thoracic masses. J Pediatr Surg. 2007; 42 (2): 420-5. https://doi.org/10.1016/j.jpedsurg.2006.10.035

  77. Liechty KW. Ex-utero intrapartum therapy. Seminars in Fetal & Neonatal Medicine. 2010; 15 (1): 34-9. https://doi. org/10.1016/j.siny.2009.05.007

  78. Jani JC, et al. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound in Obstetrics and Gynecology. 2009; 34 (3): 304-10. https://doi. org/10.1002/uog.6450

  79. Cass DL, et al. Prenatal diagnosis and outcome of fetal lung masses. J Pediatr Surg. 2011; 46 (2): 292-8. https:// doi.org/10.1016/j.jpedsurg.2010.11.004

  80. Ngamprasertwong P, et al. Update in fetal anesthesia for the ex utero intrapartum treatment (EXIT) procedure. Int Anesthesiol Clin. 2012; 50 (4): 26-40. 10.1097/ AIA.0b013e31826df966

  81. Hoagland MA, et al. Anesthesia for fetal surgery. Pediatr Anaesth. 2017;27(4):346-57. doi: 10.1111/pan.13109.

  82. Liechty KW, et al. Intrapartum airway management for giant fetal neck masses: the EXIT (ex utero intrapartum treatment) procedure. Am J Obstet Gynecol. 1997;177(4):870-4. https://doi.org/10.1016/S0002- 9378(97)70285-0

  83. Noah MM, et al. Short-term maternal outcomes that are associated with the EXIT procedure, as compared with cesarean delivery. Am J Obstet Gynecol. 2002;186(4):773-7. https://doi.org/10.1067/mob.2002.112249




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