Before determining the best course of treatment, all patients need to be evaluated in our Fetal Diagnosis and Treatment Center (FDTC) to assess whether this procedure would be a potential option for them.

The evaluation will include:

• Detailed history and physical examination
• Comprehensive prenatal ultrasound
• Fetal magnetic resonance imaging (MRI)
• Fetal echocardiogram
• Amniocentesis (sampling of amniotic fluid from the uterus) for microarray or karyotype testing to ensure we have complete information about the fetus
• Evaluation with our social work team
• Consultations with maternal fetal medicine (MFM) and pediatric surgery teams

U-M Health offers FETO to pregnant women over 18 years of age whose fetus has been diagnosed with severe CDH (left- or right-sided) without other abnormalities. Severe CDH is defined as observed-to-expected lung-to-head ratio (o/e LHR) less than 25% and with liver placement in the chest. Specifics about the trial at U-M Health can be found online at ClinicalTrials.gov (Identifier: NCT04052828).

If you qualify as a candidate for the FETO procedure, our team will discuss all risks and benefits of fetal surgery. We will explore your interest in having the procedure performed and how this will affect you and your family to determine whether proceeding with the FETO procedure is the best option for you

1. The first step is having the balloon placed. This procedure is performed in our operating room with both maternal fetal medicine (MFM) and pediatric surgery teams working together. Our anesthesiology team is present to keep you and your baby safe and comfortable during the procedure. Ultrasound guidance allows our team to assess your baby throughout the entire procedure. A tiny fetoscope (camera) is placed into your uterus and guided into your baby’s mouth. The balloon is deployed into the fetal trachea under direct vision and placement of the balloon is confirmed with ultrasound.

2. After the procedure, you will be admitted overnight for observation and continuous monitoring for uterine contractions.

3. We will have you return to our center for weekly maternal evaluations and fetal ultrasounds. Additionally, a follow-up fetal MRI will be obtained.

4. The balloon will be removed from your unborn baby’s airway weeks later.

5. Optimal delivery timing and route of delivery will be planned in consultation with our MFM team at Michigan Medicine. Route of delivery will be based on obstetric indications with vaginal delivery being the preferred approach.

After your baby is born and stabilized, your baby will be brought to the Neonatal Intensive Care Unit (NICU) and cared for with standard therapy given to all babies with CDH. With our Labor and Delivery unit uniquely nestled under the same roof as the NICU, you and your baby will remain together.

We follow all patients with CDH in our multidisciplinary, long-term CDH clinic. In this clinic we will assess the spectrum of potential long-term health issues that may affect your child.