During the perinatal appointment, an experienced physician will perform a detailed ultrasound examination to evaluate the anatomy of your unborn child. This will also help to confirm or exclude a CDH diagnosis and to determine if the diaphragm defect is isolated. The LHR and/or o/e LHR will also be determined during the appointment to assess the severity of CDH. If necessary (severe CDH), your eligibility for in-utero FETO surgery will also be checked.
FETO procedure involves the placement of a balloon into an unborn baby’s airway. The procedure is usually performed after 26-28 weeks of pregnancy in an operating theatre setting. The mother is usually given local (epidural) anesthesia (similar to that given during childbirth), and as result, she experiences no pain or discomfort. Your baby will also receive anesthesia to make it possible to perform this high-precision procedure. The balloon remains in the unborn baby’s airway during several weeks to stimulate the lungs and help them grow. This high-precision procedure must be performed by a team of experienced specialists to ensure that it is successful with a minimal risk of complications. This doubles the baby’s chance of survival after birth (in the case of severe CDH).
CDH is most commonly a structural anatomical defect that is not directly attributable to a genetic defect. In rare cases, however, it can be a sign of the presence of abnormal DNA in your baby’s genetic makeup. If this is the case, CDH is associated with other anatomical defects (e.g. a fetal heart defect, central nervous system defect) that can be diagnosed prenatally. Giving birth to a child with an isolated CDH is not an indication for testing the parents’ DNA.
The chances of CDH occurring in another child are minimal and estimated as less than 1%. Recurrence of the hernia is very uncommon.
The placement of a balloon into an unborn baby’s airway is a safe procedure. The risk of complications of the FETO surgery is very low. The most common complication is premature rupture of membranes (amniotic fluid leakage) – the risk is higher following the second FETO procedure (after balloon removal).
The placement of a balloon will not cause polyhydramnios. The balloon is placed into the unborn baby’s airway, and not into the esophagus, and therefore the procedure will not interfere with swallowing the fluid. It is CDH (rather than the balloon) and the presence of the stomach and intestines in the chest cavity result in the slower passage of amniotic fluid through the baby’s gastrointestinal tract and a gradual buildup of amniotic fluid around the baby (polyhydramnios). If polyhydramnios is confirmed, amnioreduction (reduction of amniotic fluid volume) is performed to reduce the risk of preterm birth. Amnioreduction should be performed in the same center where (if delivery occurs) the baby can be transferred under the care of a team of neonatologists and surgeons without any need for transport.
It is important to properly choose the medical care center where the FETO procedure and surgery will be performed. Ideally, it should be the same center. All the procedures related to prenatal diagnostic workup, in-utero surgery (FETO), delivery and hernia repair surgery can take place in one hospital. Before your baby is born, a medical case conference (counselling) is conducted, during which a team of obstetricians, neonatologists and surgeons makes preparations for the delivery of a child with a severe birth defect. Transport has a very negative impact on babies with CDH, and therefore any in-utero procedures should be performed in a center where, in the event of delivery, the baby can be directly transferred, without transport, into the care of doctors and surgeons in the neonatal intensive care unit. It is important to choose a medical facility that has the most experience in performing FETO procedures and providing care to pregnant mothers of babies diagnosed with CDH.
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