Fetoscopic Endoluminal Tracheal Occlusion (FETO) for Congenital Diaphragm Hernia

Inclusion Criteria:

1. Pregnant women age 18 years and older

2. Singleton pregnancy

3. Normal fetal karyotype with confirmation by culture results. Results by fluorescence
in situ hybridization (FISH) will be acceptable if the patient is > 26 weeks

4. Isolated Left CDH with liver up

5. LHR < 25% - Gestation age at enrollment prior to 29 wks plus 6 days; O/E LHR 25- <30%
- gestation age at time of enrollment prior to 31 wks plus 6 days

6. SEVERE pulmonary hypoplasia with US O/E LHR < 25% (measured at 18 weeks plus 0 days to
29 weeks plus 5 days) at the time of surgery; O/E LHR 25- <30% (measured at 30 weeks
plus 0 days - 31 weeks plus 6 days) at time of surgery.

7. Gestational age at FETO procedure with O/E LHR < 25% at 27 weeks plus 0 days to 29
weeks plus 6 days; O/E LHR 25- <30% at FETO procedure at 30 weeks plus 0 days - 31
weeks plus 6 days as determined by clinical information (LMP) and evaluation of first
ultrasound.

8. Patient meets psychosocial criteria

9. Informed consent

Exclusion Criteria:

1. Patient < 18 years of age

2. Multi-fetal pregnancy

3. History of natural rubber latex allergy

4. Preterm labor, cervix shortened (<15 mm at enrollment or within 24 hours of FETO
balloon insertion procedure) or uterine anomaly strongly predisposing to preterm
labor, placenta previa

5. Psychosocial ineligibility, precluding consent:

- Inability to reside within 30 minutes of The Fetal Center at Children's Memorial
Hermann Hospital. and inability to comply with the travel for the follow-up
requirements of the trial

- Patient does not have a support person (e.g. spouse, partner, mother) available
to stay with the patient for the duration of the pregnancy at The Fetal Center at
Children's Memorial Hermann Hospital.

6. Right sided CDH or bilateral CDH, isolated left sided with O/E LHR ≥25% (measured at
18 weeks 0 days to 29 weeks 5 days) as determined by ultrasound[1]

7. Additional fetal anomaly and chromosomal abnormalities by ultrasound, MRI, or
echocardiogram at the fetal treatment center. No cases will be removed post hoc if
abnormalities are discovered in the course of post-operative monitoring

8. Maternal contraindication to fetoscopic surgery or severe maternal medical condition
in pregnancy

9. History of incompetent cervix with or without cerclage

10. Placental abnormalities (previa, abruption, accrete) known at time of enrollment

11. Maternal-fetal Rh isoimmunization, Kell sensitization or neonatal alloimmune
thrombocytopenia affecting the current pregnancy

12. Maternal HIV, Hepatitis-B, Hepatitis-C status positive because of the increased risk
of transmission to the fetus during maternal-fetal surgery. If the patient's HIV or
Hepatitis status is unknown, the patient must be tested and found to have negative
results before enrollment

13. Uterine anomaly such as large or multiple fibroids or mullerian duct abnormality

14. There is no safe or technically feasible fetoscopic approach to balloon placement

15. Participation in another intervention study that influences maternal and fetal
morbidity and mortality or participation in this trial in a previous pregnancy