Fetal Surgery and the EXIT Procedure

With advancements in prenatal diagnostics, many fetal conditions are diagnosed early during fetal life. Some of these conditions lead to more favorable outcomes if treated during the fetal period. This has led to an increase in fetal procedures. Fetal procedures include minimally invasive procedures, open midgestational procedures, and ex-utero intrapartum procedures. The anesthetic management of each is based on an understanding of the fetal pathology, uteroplacental unit, and maternal and fetal physiology. While minimally invasive procedures can be carried out under local and regional anesthesia, general anesthesia is preferred for midgestation open procedures. Fetal monitoring, analgesia, preparation for fetal resuscitation, and maintenance of uterine relaxation are unique to these surgeries. Maternal safety and maintenance of maternal hemodynamics are of utmost importance for these surgeries.