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CC BY-NC-ND 4.0 · AJP Rep 2023; 13(04): e89-e93
DOI: 10.1055/a-2188-6538
Case Report

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

Steven T. Papastefan 
1   Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
2   Department of Pediatric Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
3   The Chicago Institute for Fetal Health, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
,
Federico Scorletti
3   The Chicago Institute for Fetal Health, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
4   Department of Medical and Surgical Neonatology, Neonatal Surgical Unit, Bambino Gesù Children's Hospital, Rome, Italy
,
Amir M. Alhajjat
1   Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
2   Department of Pediatric Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
3   The Chicago Institute for Fetal Health, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
,
Katherine C. Ott
1   Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
2   Department of Pediatric Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
3   The Chicago Institute for Fetal Health, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
,
Jeffrey C. Rastatter
5   Department of Otorhinolaryngology-Head and Neck Surgery, Lurie Children's Hospital of Chicago, Chicago, Illinois
6   Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Xavier F. Pombar
3   The Chicago Institute for Fetal Health, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
7   Department of Obstetrics and Gynecology, Rush University, Chicago, Illinois
,
Aimen F. Shaaban
1   Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
2   Department of Pediatric Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
3   The Chicago Institute for Fetal Health, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
› Author Affiliations Funding This study was supported by the Ann & Robert H. Lurie Children's Hospital Research Foundation (A.S.).
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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.




Publication History

Received: 07 April 2023

Accepted: 02 October 2023

Accepted Manuscript online:
10 October 2023

Article published online:
12 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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