Ex-Utero Intrapartum Treatment-to-Airway for Obstructing Fetal Neck Masses: A Singular Methodology for Monochorionic and Dichorionic Twin Pregnancies

Abstract

Fetal airway obstruction in one twin of a diamniotic pregnancy presents unique challenges. Very few cases of ex-utero-intrapartum-treatment (EXIT) procedures for twin pregnancy have been reported and only in dichorionic pregnancies. We report a singular methodology for EXIT-to-airway procedures in two pregnancies involving monochorionic and dichorionic twins.

Two cases of EXIT-to-airway in twin pregnancies were performed in 2018 and 2019 at a regional fetal treatment center. Case 1 involved a giant cervical teratoma in a monochorionic-diamniotic twin pregnancy with preterm labor at 29 weeks. Case 2 involved a dichorionic-diamniotic pregnancy with a large cervical lymphatic malformation with preterm labor at 36 weeks. In each case, the polyhydramnios caused the affected twin's amniotic sac to be the presenting sac for the surgical approach. Bronchoscopy and successful intubation was completed after 22 and 10 minutes of uteroplacental bypass, respectively. The bystander twins were delivered second without intubation and resuscitated without perinatal distress.

EXIT-to-airway appears to be a reasonable option for twins including monochorionic pregnancies, via delivery of the affected twin first followed by delivery of the bystander twin. Thoughtful preparation and counseling by an experienced multidisciplinary team permits an EXIT-to-airway approach for twin pregnancies even in an emergent setting.

Keywords

EXIT-to-airway - fetal neck mass - monochorionic - dichorionic - lymphatic malformation - cervical teratoma - twin pregnancy - airway obstruction

Ethical Approval

Ethical approval is not required for this study in accordance with local or national guidelines. Written informed consent was obtained from the patient for publication of the details of their medical case and any accompanying images.

Author Contributions

S.P., F.S., and A.S were responsible for conception and design of study. S.P., F.S., and A.S. performed acquisition of data (laboratory or clinical). F.S. performed data analysis and/or interpretation. F.S., S.P., and A.S. drafted the manuscript. X.F., A.A., K.C., and J.R. provided critical revision. A.S. provided approval of final version of manuscript.

Data Availability

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Publikationsverlauf

Eingereicht: 07. April 2023

Angenommen: 02. Oktober 2023

Accepted Manuscript online:
10. Oktober 2023

Artikel online veröffentlicht:
12. Dezember 2023

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