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New Fetal Therapy Program Performs Utah's First EXIT Procedure

Apr 24, 2008 9:00 AM

Elizabeth Sanders was 20 weeks pregnant when she and her husband learned during an ultrasound that something was wrong with their baby. The images showed a mass around the baby’s neck, possibly a tumor, that could make it impossible for the girl to breathe after delivery.

Sanders, a resident of Sandy, Utah, was referred to a maternal fetal medicine specialist at St. Mark’s Hospital who delivered even more bad news--the procedure that provided the baby with the best chance for survival had never been done in Utah.

At the direction of the referring physician, Sanders found her way to Jan Byrne, M.D., associate professor of obstetrics and gynecology and director of the University’s Fetal Therapy Program. After reviewing the case and meeting with Sanders, as well as the referring physician and colleagues from five other departments, Byrne gave the expectant mom some muchneeded good news: the University, with help from Primary Children’s Medical Center, Intermountain Medical Center, and St. Mark’s Hospital, had the resources and expertise to perform the complicated procedure.

“I don’t know that anyone ever wants to be the first to undergo a procedure,” said Sanders. “But I felt very comfortable knowing that so many committed people were going to be part of the delivery.”

Known as an Ex Utero Intrapartum Treatment, or EXIT, the procedure involves partially delivering a baby via Caesarean section, and then intubating the baby to secure the airway before completing the delivery and cutting the umbilical cord. Only a handful of hospitals in the country perform the procedure.

On Jan. 14, two surgical teams, one for Sanders and one for her baby, performed the EXIT procedure in University Hospital’s Labor and Delivery operating room. The operation went as expected and the baby was passed through the window connecting the operating room to the Newborn Intensive Care Unit. Once the baby was stabilized, she was transferred to Primary Children’s Medical Center.

“We had more than 20 people representing three different hospitals and five different specialties involved in this procedure, so we had to make sure everything was well-scripted,” said Byrne. “Both teams had practiced beforehand and we all felt very comfortable about our roles.” One week later, another EXIT procedure was successfully performed.

Byrne says this collaboration is what makes the Fetal Therapy Program possible. “No one hospital, or health system could do this alone. As faculty members, we’ve always had collaborative relationships across specialties,” she said. “But this new program, which is a collaboration between the maternalfetal medicine programs at University Health Care and Intermountain Health Care, formalizes these relationships and, ultimately, makes it easier for patients with complex pregnancies to access our services.” Byrne also expects this collaboration to expand research questions and projects.

While EXIT procedures are the most complex surgical intervention the program coordinates, there are other postnatal surgical procedures for conditions such as diaphragmatic hernias and neural tube defects. Fetal dysrhythmias and Rh disease are treated in utero. Care of patients with fetal cardiac defects is coordinated with the Fetal Cardiology Program. Twin-twin transfusion syndrome is an area of active research, although laser treatment is not currently available at the University. The program also manages pregnancies with known birth defects and abnormalities where there is no surgical intervention possible.

Ultimately, the new Fetal Therapy Program serves as a resource to help coordinate the complexities of prenatal and peripartum courses for parents such as the Sanders. “We evaluate each case individually and bring together all our resources to do what’s best for the mom and the baby,” she said.

Scarlett Sanders is now 3 months old and doctors have determined the neck mass was not a tumor, but lymphatic cysts. During the next year, doctors at Primary Children’s Medical Center will try to shrink the cysts with injections of a mixture of antibiotics and alcohol.

“We had so many worries before she was born, but everything turned out so much better than we expected,” says Sanders. “She's the most precious, little baby and we just love her so much.”

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