Intrapartum management strategies for congenital cervical teratoma: the EXIT procedure (ex utero intrapartum treatment)

Abstract

Cervical teratomas are 3 to 5% of all teratomas and have an incidence of 1:20,000 to 1:40,000 live-borns. M.J.F., 31-years-old, had done a routine scan during pregnancy that evidenced a large fetal neck mass with teratoma cervical sonographic aspect. An interdisciplinary reunion decided for expectant management until pregnancy term when C section with EXIT procedure would be performed. At 34 weeks occurred spontaneous preterm labor and the interdisciplinary team was contacted. After head exteriorization a large neck mass was noticed. The EXIT procedure was performed allowing a tranquil orotracheal intubation while placental circulation was sustained. At third day the patient presented hypoxia, decreased heart rate and central cyanosis developing cardiorespiratory failure with unsuccessful response to resuscitation. Cervical teratoma is a rare fetal condition that is very important an interdisciplinary approach performing EXIT procedure to allow an adequate respiratory assistance at delivery. Intensive neonatal care is essential to improve patient outcome.