Successful combined spinal–epidural anaesthesia for EXIT procedure in foetal goitre associated with maternal Graves’ disease: a case report

Saad, Siti Nadzirah and Mohd Najib, Nazuha and Abdul Rahim, Shahir Asraf (2026) Successful combined spinal–epidural anaesthesia for EXIT procedure in foetal goitre associated with maternal Graves’ disease: a case report. Malaysian Journal of Anaesthesiology (MyJA), 5 (1). pp. 100-107. ISSN 2772-9524 E-ISSN 2949-7787

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Abstract

The ex-utero intrapartum treatment (EXIT) procedure is a rare, but lifesaving intervention performed during a Caesarean section to enable controlled foetal airway and other intrapartum procedures. Its main goal is to secure the foetal airway while maintaining utero-placental circulation, preventing airway obstruction at birth. The EXIT procedure is preferred in conditions such as congenital high airway obstruction syndrome and airway compression from neck or thoracic masses. This case report details the management of a 22-year-old primigravida with Graves’ disease whose foetus was diagnosed with an anterior neck mass consistent with thyroid goitre. Antenatal ultrasound and magnetic resonance imaging confirmed a lesion anterior to the trachea. After multidisciplinary discussion between the obstetrician, obstetric anaesthesiologist, and paediatric otorhinolaryngology teams, an emergency Caesarean section with an EXIT procedure was performed at 37 weeks and 3 days. Anaesthesia was provided using a combined spinal-epidural technique. Nitroglycerin facilitated uterine relaxation, and phenylephrine maintained maternal hemodynamic stability. Foetal tracheal intubation was successfully performed under direct laryngoscopy while placental circulation was preserved. This case highlights the success of combined spinal-epidural anaesthesia in avoiding a potential high-risk airway complication to the mother and secure the foetal airway while oxygenating the foetus via the placenta.

Item Type:	Article (Case Report)
Uncontrolled Keywords:	airway management, combined spinal-epidural anaesthesia, ex-utero intrapartum treatment (EXIT), foetal goitre; Graves’ disease
Subjects:	R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care Sultan Ahmad Shah Medical Centre (SASMEC)
Depositing User:	DR SHAHIR RAHIM
Date Deposited:	12 Aug 2026 22:59
Last Update:	12 Aug 2026 22:59
Queue Number:	2026-08-Q4694
URI:	http://irep.iium.edu.my/id/eprint/129966

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