Bicornuate uterus breech presentation with Pierre Robin fetu
Thorough prenatal evaluation allows for identification of fetuses with compromised airway. The ex utero intrapartum treatment procedure enables maintaining uteroplacental circulation during cesarean section while securing a potentially obstructed fetal airway, converting a potentially catastrophic situation into a controlled one. An expert multidisciplinary team is the key to success. The present case appears in the journal Clinical Case Reports.

Prenatal diagnosis of fetal craniomaxillofacial or cervical malformation obstructing the upper airway is essential to reduce perinatal morbidity and mortality, allowing for maternal‐fetal monitoring during pregnancy and defining the best approach for delivery. EXIT procedure is indicated almost in any situation in which the fetal airway might be compromised during delivery.

A 31‐year‐old, gravida 4, para 1, woman was referred due to suspected fetal Pierre Robin sequence, at 34 + 6 weeks of gestation. A difficult intubation was anticipated, and the possibility of achieving surgical airway in an EXIT procedure was planned. The woman, which is known to have a bicornuate uterus, had previously undergone a cesarean section during her first labor due to breech presentation at 39 weeks of gestation.

The child was born weighing 2710 g with micrognathia and cleft palate, not requiring an EXIT procedure. She also underwent two spontaneous abortions at 8 weeks of gestation. A prenatal magnetic resonance imaging (MRI) at 32 + 2 weeks of gestation (Figure 1) and an ultrasound (US) demonstrated severe micrognathia. Fetal echocardiography and genetic consultation were normal.

Amniocentesis was not performed due to maternal refusal. At 35 + 2 weeks of gestation, a two‐dimensional US (Figure 2) was repeated and a three‐dimensional US was performed (Figure 3) to evaluate in more detail the fetal anatomy and growth. US showed polyhydramnios, dropped tongue, posterior pharynx, and retrognathia‐micrognathia. No palate was observed.

While the delivery was planned to 37 weeks of gestation (for fetal lung maturity),7 at 35 + 3 weeks of gestation, the patient started feeling regular uterine contractions, and it seemed as she was going into spontaneous labor. Contraction stress test was negative, US showed breech presentation, and the blood pressure and pulse were within normal ranges.


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