Multidisciplinary Management of Ex Utero Intrapartum Treatment Procedure for a Large Cervical Mass—A Case Report and Review of Literature

Intrapartum management of babies with life-threatening airway obstruction is challenging and requires meticulous planning to achieve a positive outcome. The inability to maintain a patent airway after birth carries the risk of neonatal hypoxia leading to death or long-term disability. In these cases, the mother is anesthetized for cesarean section and the baby is partially delivered out; and airway is secured while the baby is still on placental support. Important elements in the maternal management include maintenance of uterine relaxation to prevent placental separation, and then using uterotonics to avoid postpartum hemorrhage. Airway management in the baby has to follow a preplanned algorithmic protocol for dealing with the different contingencies encountered. The successful long-term outcome also necessitates meticulous management in the neonatal period, and afterward. This is a case report of ex utero intrapartum treatment procedure for a large cervical mass, illustrating the importance of multidisciplinary planning of equipment and management pathways, execution of the procedure, and then postnatal and long-term management of the child. We also include a review of the Indian experience and discuss the reasons for poor long-term outcomes in four out of nine babies reported in the literature.