FETO for congenital diaphragmatic hernia: who may benefit?

Congenital diaphragmatic hernia allows abdominal organs to enter the fetal chest and can restrict lung development. Prognosis varies widely. FETO—fetoscopic endoluminal tracheal occlusion—places a detachable balloon in the fetal trachea for a defined period to retain lung fluid and stimulate lung growth.

Severity assessment comes first

Evaluation usually includes detailed anatomy, side of the defect, observed-to-expected lung-to-head ratio, liver position, gestational age, fetal echocardiography, genetic testing, and review for additional abnormalities. Measurements must be obtained and interpreted by teams familiar with CDH because technique and reference standards affect classification.

Evidence is severity-specific

Randomised evidence in isolated severe left-sided CDH found improved survival to hospital discharge with FETO, accompanied by increased risks of preterm prelabour rupture of membranes and preterm birth. A separate trial in moderate left-sided disease did not show a significant improvement in its primary survival outcomes. These findings are why “CDH” alone is not an indication for FETO.

Balloon removal is part of the treatment

FETO requires a plan for balloon removal, usually by a later fetoscopic procedure or another established retrieval pathway. Families must know what to do if labour, membrane rupture, bleeding, or maternal illness occurs while the balloon is in place. Emergency access to a team capable of securing the fetal or neonatal airway is essential.

The neonatal pathway remains critical

FETO does not repair the diaphragm. After birth, the baby may require advanced ventilation, pulmonary-hypertension management, intensive care, and postnatal surgical repair. Counselling should cover survival, respiratory morbidity, feeding, neurodevelopment, recurrence, and long-term multidisciplinary follow-up.

The dated programme-status panel classifies the FETO pathway and its qualification. Assessment remains subject to strict case-specific eligibility, programme criteria, a confirmed balloon-removal pathway, governance, and informed consent.