Case scenario: anesthesia for maternal-fetal surgery: the Ex Utero Intrapartum Therapy (EXIT) procedure.

F ETAL anomalies such as giant neck masses can result in perinatal death or hypoxia and anoxic brain injury due to inability to secure an airway in a timely fashion after delivery. Modern technology, ultrasound, and ultrafast magnetic resonance imaging have enabled intrauterine diagnosis and fetal interventions as a mode of therapy, thereby giving such affected fetuses a chance at survival. Initially, the Ex Utero Intrapartum Therapy (EXIT) procedure was exclusively performed in large tertiary children’s hospitals because of the easy availability of pediatric practitioners who can adequately manage the baby-related issues. These hospitals are often in close proximity to or affiliated with maternal obstetric units and involve a multidisciplinary team approach to provide care for both mother and baby. However, these types of procedures are increasingly being performed in diverse hospital settings; therefore, adequate knowledge about the related intricacies of these cases is warranted. We present the case of a mother carrying a fetus of 37 weeks’ gestation with a giant cervical teratoma who underwent the EXIT procedure for fetal airway access. This discussion will focus on the multiple management issues and concerns to be contemplated before embarking on the care of a pregnant mother whose child may need surgery shortly before delivery to ensure neonatal survival.