# Cesarean section with operation on placental support as an adapted EXIT procedure for fetal thyroid goiter: A case report and literature review

## TL;DR

A modified cesarean section technique with placental support is presented as a viable option for delivering babies with airway blockages, particularly in areas with limited medical resources.

## Contribution

The paper introduces a simplified cesarean delivery method with placental support as an adapted EXIT procedure for fetal airway obstruction.

## Key findings

- 12 of 15 cases involved fetal anomalies requiring airway intervention during delivery.
- Intubation was successful in 58% of cases where direct laryngoscopy was attempted.
- Only one case of postpartum hemorrhage occurred, indicating the procedure's safety profile.

## Abstract

The ex‐utero intrapartum treatment (EXIT) procedure is a specialized delivery strategy that extends utero–placental–fetal circulation to convert a potential neonatal emergency condition into a condition that is compatible with postnatal life. Cesarean section with operation on placental support is an EXIT technique that requires a relatively short duration of placental support and few skilled medical personnel and specialized instruments; it can successfully treat selected fetal indications. In the present study, we report a case of fetal thyroid goiter as an example of a fetal anomaly requiring the procedure. We then review all cases published in the medical literature that were similar to our procedure (15 cases including our new case). Twelve (80%) cases of fetal anomalies and three prophylactic cases of extremely low birth weight were delivered using a procedure adapted from the standard EXIT procedure. All 12 cases of fetal anomalies were treated by airway intervention. In 12 of the 15 cases (80%), direct laryngoscopy and endotracheal intubation were attempted; intubation was successful in seven of these 12 cases (58%). There was only one case of postpartum hemorrhage caused by uterine incisional bleeding, with a consequence of delayed hysterotomy closure. In summary, cesarean section with operation on placental support is a promising alternative delivery technique for neonates with airway obstructive lesions, especially in resource‐limited settings.

Cesarean section with operation on placental support is an alternative delivery strategy for some fetuses with airway obstructive lesions, especially in resource‐limited settings.