Fetal Endoscopic Tracheal Occlusion (FETO) for Severe Congenital Diaphragmatic Hernia

Inclusion Criteria

• •Maternal Age: 18-50
• •Singleton gestation
• •Gestational age before 29 weeks 6 days
• •Severe left or right-sided CDH: For severe left sided CDH observed-to-expected lung-to- head ratio (o/e LHR) less than 25% between 22 and 29 6/7 weeks' gestation, liver herniation, MRI lung volumes less than 30% expected based on gestational age nomograms. For severe right sided CDH o/e LHR less than 30 % between 22 and 29 6/7 weeks' gestation, liver herniation, MRI lung volumes less than 30% expected based on gestational age nomograms.
• •Normal genetic karyotype or microarray testing by amniocentesis or chorionic villus sampling (CVS)
• •Absence of associated fetal structural cardiac anomalies by a dedicated fetal echocardiogram
• •Absence of other structural anomalies by ultrasound or MRI
• •Appropriate multi-disciplinary counseling performed with maternal-fetal medicine, neonatology, pediatric surgery, genetics, pediatric otolaryngology (ENT).
• •Must be willing to remain near LPCH Stanford (within 30 minutes from the hospital) for the duration of the balloon placement.
• •No maternal and/or fetal contra-indications to fetal surgery such as a bleeding disorder, poorly controlled diabetes or hypertension, short cervix (measuring \< 20mm), risk for preterm birth etc.
• •Planned pregnancy surveillance at LPCH Stanford
• •Planned delivery at LPCH Stanford
• •Able to provide written consent
• •Willingness to comply with all study procedures and availability (meets psychosocial criteria) for the duration of the study including having a support person