Comparison between Fetal Endoscopic Tracheal Occlusion Using a 1.0-mm Fetoscope and Prenatal Expectant Management in Severe Congenital Diaphragmatic HerniaRuano R. · Duarte S.A. · Pimenta E.J.d.A. · Takashi E. · da Silva M.M. · Tannuri U. · Zugaib M.
Departments of aObstetrics and bPediatric Surgery, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Objectives: To evaluate if fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) using a 1.0-mm fetoscope improves neonatal outcome. Method: Between January 2006 and December 2008, a controlled study was conducted at a single center in which FETO was proposed for fetuses with severe isolated CDH (lung-to-head ratio <1.0) and liver herniation to the thoracic cavity but no other detectable anomalies at diagnosis (<26 weeks). FETO was performed under maternal epidural and fetal intramuscular anesthesia, guided by ultrasonography and 1.0-mm fetoscope between 26 and 30 weeks. All cases submitted to FETO were delivered by ex utero intrapartum therapy procedure. Postnatal therapy was the same for both treated fetuses and controls. The primary outcome was neonatal survival (up to 28 days after birth). Results: A total of 35 women met the inclusion criteria, and in 17 of them, fetal intervention was intended. However, in 1 case, it was not possible to insert the balloon inside the fetal trachea because of placental bleeding. FETO was therefore successfully performed in 16 fetuses with severe CDH. Eighteen cases received no prenatal intervention and served as the control group. Mean gestational age at diagnosis was similar in both groups (p > 0.05). Delivery occurred at 35.6 (range: 28–38) weeks in the FETO group and at 37.5 (range: 31–40) weeks (p = 0.18) among controls. Nine of 17 (52.9%) infants in the FETO group and 1 of 18 (5.6%) in the control group survived (p < 0.01). Severe pulmonary arterial hypertension was present in 8/17 (47.1%) infants from the FETO group and in 16/18 (88.9%) controls (p = 0.01). Conclusion: The present study shows that FETO using a 1.0-mm fetoscope is feasible and may improve neonatal outcome in severe CDH.
Department of Obstetrics, Faculty of Medicine, University of São Paulo
Rua Valentim Magalhães, 100, ap 52
São Paulo, SP 03184-090 (Brazil)
Tel./Fax +55 116 601 6280, E-Mail firstname.lastname@example.org
Preliminary results of the study were presented at the 27th Meeting of the International Fetal Medicine and Surgery Society in Athens, Greece, in 2008, and at the 19th World Congress on Ultrasound in Obstetrics and Gynecology in Hamburg, Germany, in 2009.
Received: September 24, 2009
Accepted after revision: February 2, 2010
Published online: April 10, 2010
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 3, Number of References : 43
Fetal Diagnosis and Therapy (Clinical Advances and Basic Research)
Vol. 29, No. 1, Year 2011 (Cover Date: February 2011)
Journal Editor: Gratacós E. (Barcelona)
ISSN: 1015-3837 (Print), eISSN: 1421-9964 (Online)
For additional information: http://www.karger.com/FDT