Ex-utero intrapartum treatment of a breech fetus: a case report and review of the literature

INTRODUCTION: The surgical technique for ex utero intrapartum treatment (EXIT) has been well-established for fetuses in cephalic presentation. EXIT for a fetus in a breech lie presents surgical challenges and requires modification. SUMMARY: We describe EXIT on a fetus in a breech lie and with multiple congenital anomalies, including micrognathia, bilateral cleft lip, and a sizeable neural tube defect at 36 + 3 weeks of gestation when the mother presented after preterm prelabor rupture of membranes (PPROM). CONCLUSIONS: Hysterotomy in the uterine fundus is feasible for partial delivery of a breech fetus for EXIT if the placental margin is >2 cm away from the incision site. A power surgical stapler is an effective tool to perform a hysterotomy in the uterine fundus. Timely simulation-based training is a valuable tool to prepare for infrequent but high-stakes procedures.