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Obstetrics & Gynecology 1999;93:824-825
© 1999 by The American College of Obstetricians and Gynecologists
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OBSTETRICS

THE EX UTERO INTRAPARTUM TREATMENT PROCEDURE FOR A LARGE FETAL NECK MASS IN A TWIN GESTATION

Kenneth W. Liechty, MD, Timothy M. Crombleholme, MD, Stuart Weiner, MD, Brian Bernick, Alan W. Flake, MD and N. Scott Adzick, MD

From The Center for Fetal Diagnosis and Treatment, The Department of Surgery, The Children’s Hospital of Philadelphia, the University of Pennsylvania School of Medicine, and The Departments of Obstetrics and Gynecology, Pennsylvania Hospital, and The Jefferson Medical Center, The Thomas Jefferson School of Medicine, Philadelphia, Pennsylvania.

Address reprint requests to: Timothy M. Crombleholme, MD The Children’s Hospital of Philadelphia Abramson Pediatric Research Center 1102C 34th Street and Civic Center Boulevard Philadelphia, PA 19104 E-mail: crombleholme{at}email.chop.edu

Background: Large fetal neck masses can make it difficult or impossible to secure airways at birth, with associated risks of hypoxia, brain injury, and death. Based on a MEDLINE search from 1966 to June 1998, using the keywords EXIT procedure, placental support, twins, and neck mass, we report the first ex utero intrapartum treatment procedure performed in a twin gestation complicated by a large fetal neck mass.

Case: A giant fetal cervical mass was diagnosed in one fetus of a 20-week twin gestation by sonography and magnetic resonance imaging. At 35 weeks’ gestation, the ex utero intrapartum treatment procedure was performed successfully for delivery of the normal twin, followed by intrapartum airway access of the twin with the neck mass.

Conclusion: Even in twin gestations, the ex utero intrapartum treatment procedure is the delivery method of choice for fetuses with giant neck masses.






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