The "Ex Utero Intrapartum Treatment" (EXIT) procedure is a specialized surgical technique used during cesarean delivery to perform life-saving fetal interventions while maintaining placental circulation. By preserving feto-placental gas exchange, EXIT enables the treatment of severe conditions such as predictable severe breathing difficulties at birth. EXIT's origins date back to removing tracheal occlusion devices used for congenital diaphragmatic hernias. It has since expanded to treat conditions such as congenital high airway obstruction syndrome and airway compression by masses. Despite the risks of adverse maternal and fetal events, it shows high perinatal survival rates. The success of EXIT depends on an accurate prenatal diagnosis through fetal ultrasound and magnetic resonance imaging. Anesthetic management differs from standard cesarean sections, balancing the need for uterine relaxation and avoiding maternal-fetal risks. Inhaled anesthetics are preferred, although recent studies suggest the potential of neuraxial anesthesia combined with tocolytics. Although the EXIT procedure can be performed safely in specialized centers, it does carry risks for both the mother and the fetus. Neonatal mortality and complications vary depending on indications and postnatal management. Research and clinical practice must advance to improve safety and efficacy.

Foetal echogenic lungs are characterised by the appearance of small bright spots within the foetal lungs observed via antenatal ultrasound, which may indicate underlying developmental abnormalities. The presence of echogenic lungs is a rare sonographic finding identified during the first trimester of pregnancy. In this report, we present the case of a healthy 25-year-old primigravida who was found to have multiple foetal abnormalities in her routine first-trimester scan, following which she was scanned by the foetal medicine team, who confirmed the finding of foetal echogenic lungs along with cystic hygroma and hydrops foetalis. Turner's syndrome was confirmed with successive invasive tests, and the pregnancy was terminated at 14 weeks. Our findings not only contribute to the limited data on this rare sonographic occurrence but also highlight the importance of vigilant foetal monitoring in cases of echogenic lungs, allowing for timely intervention and management strategies. This case strongly supports the need for further research into the implications of echogenic lung findings and their association with chromosomal abnormalities.

Management of fetal airway obstruction requires a multidisciplinary approach to optimize the safety of the pregnant patient and fetus. For severe cases of fetal airway obstruction, ex-utero intrapartum treatment (EXIT) is recommended. This review highlights indications and rationale for EXIT and presents an approach to fetal airway management from an otolaryngologic perspective. Approach to the fetus with airway obstruction differs in the literature. Recent studies have sought to identify prenatal risk factors that portend the need for surgical intervention at delivery, with identification of three fetal anomalies that justify delivery modification: micrognathia, congenital high airway obstruction, and head and neck masses. There remains heterogeneity within this cohort, contributing to the varied approach to fetal airway obstruction. What remains consistent is the need for early identification of at-risk fetuses and multidisciplinary input throughout pregnancy to ensure that the appropriate teams are present at delivery. EXIT is a mainstay in the management of fetal airway obstruction, as it enables airway intervention while preserving uteroplacental circulation. Further research is needed to define indications for EXIT and develop management algorithms starting from identification of airway obstruction on prenatal imaging. Multidisciplinary collaboration is tantamount to a successful procedure.

Congenital thoracic mass lesions are generally benign but can cause significant morbidity and mortality due to airway obstruction. This study highlights the role of perinatal autopsy in identifying these lesions and correlates autopsy findings with prenatal imaging. A retrospective analysis of fetal autopsies with thoracic mass lesions was conducted over 9 years. A standardized autopsy protocol, including fixation, photography, foetogram, external examination, en-bloc removal, internal examination, and organ block dissection, was followed and compared with prenatal imaging results. Of 426 fetal autopsies, 20 (4.6%) had thoracic mass lesions. The most common lesion was diaphragmatic hernia (9 cases, 45%), followed by congenital high airway obstruction syndrome (3 cases, 15%). Agreement with prenatal ultrasonography was observed in only 4 cases (20%). Fetal autopsy is crucial for identifying thoracic mass lesions and determining the cause of death, aiding in genetic counseling and management of future pregnancies.

To correlate ultrasound findings with fetoscopy and pathology data in patients with suspected congenital high airway obstruction syndrome (CHAOS) to improve prenatal diagnosis and management. This study included five consecutive patients suspected of having CHAOS. Prenatal ultrasound was performed to identify key features such as bilateral hyperechoic lungs, eversion of the diaphragm, and visible airways. Fetoscopy was conducted in three patients to assess the vocal cords and upper airways. Pathological analysis was also used to confirm the diagnosis. All five patients showed bilateral hyperechoic lungs, eversion of the diaphragm, and visible airways on ultrasound. An obstructive block was seen in all cases and the vocal cords were not visualized in three cases, abnormal in one case and not mentioned in one case. Fetoscopy confirmed vocal cord fusion or absence and complete laryngeal atresia in three patients. All pregnancies were terminated; therefore, medium-term complications of fetoscopy could not be assessed. Accurate prenatal ultrasound imaging is essential for diagnosing CHAOS and determining prognosis. While ultrasound is the first-line test to assess the condition and guide management, fetoscopy should only be proposed when ultrasound findings are inconclusive. The diagnostic and therapeutic value of fetoscopy is limited to cases with nonvisible vocal cords and obstructive laryngeal block.