Prenatal diagnosis can show masses of the fetal neck, mouth, and face that
can potentially cause respiratory distress at birth. To prevent such an eme
rgency, the EXIT (ex utero intrapartum technique) is performed: it is the i
ntrapartum intubation of the fetus at term while still connected to the pla
centa. The EXIT procedure was first performed in a case of cervical teratom
a. Up to now a total of 34 cases are described, mostly cervical teratomas (
13 cases), lymphangiomas (7), epignathus (3); babies' outcome has been succ
essful in 25 of them, with one death related to the procedure. Among the re
ported cases we are aware of only one where EXIT was performed in a twin ge
station, in which the normal twin was delivered first. In our case the norm
al fetus was posterior to the twin with cervical malformation, requiring us
to work on the latter while the former was still in the uterus. After havi
ng safely secured the airway in twin A, twin B was prompt delivered with ex
cellent general conditions. Our limited experience enlarges the possibility
to perform this prenatal procedure even in "nonstandard" conditions, such
as a twin gestation, and may prove useful to those who are going to deal wi
th such issues.