Neonatal and maternal outcomes of scheduled versus unscheduled ex-utero intrapartum treatment (EXIT) procedures

OBJECTIVE: Ex-utero intrapartum treatment (EXIT) procedures are employed during delivery to establish a safe airway on placental support for neonates with potential airway obstruction. While EXITs are typically planned with a multidisciplinary team, these procedures may occur emergently due to preterm labor, late diagnosis, or delayed transfer of care. This systematic review compares outcomes of scheduled versus unscheduled/emergent EXIT procedures. DATA SOURCES: We searched PubMed, Scopus, and CINAHL in March 2025 to identify observational studies describing EXIT procedures. METHODS: Studies were included if they identified the procedure as scheduled/unscheduled and had at least one neonatal and maternal outcome of interest. We assessed quality using the Joanna Briggs Institute (JBI) checklists. Raw data were pooled and assessed with summary statistics. RESULTS: 67 articles were included for data extraction and synthesis. Primary findings were: (1) the unscheduled group had a significantly higher maternal estimated blood loss (EBL) and (2) rates of neonatal perioperative mortality were higher for the unscheduled group. Though the mortality difference was clinically significant (16% unscheduled versus 4.9% scheduled), it was not statistically significant. Furthermore, a higher percentage of patients in the unscheduled group were managed with tracheostomy (49%) as compared to the scheduled group (30%, p-value variable across imputation sets, range 0.029 - 0.076). CONCLUSION: EXIT procedures should always be carefully planned and coordinated with a multidisciplinary team. However, if necessary, unscheduled EXIT procedures can be safely performed by experienced personnel in prepared centers, though they may have a slight increase in maternal EBL.