J Obstet Gynaecol Res

. 2020 Sep 28. doi: 10.1111/jog.14504. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/32989906/

Feasibility and outcomes of fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: A Japanese experience

Seiji Wada ¹, Katsusuke Ozawa ¹, Rika Sugibayashi ¹, Fumio Suyama ¹, Shoichiro Amari ¹, Yushi Ito ¹, Yutaka Kanamori ², Hiroomi Okuyama ³, Noriaki Usui ⁴, Jun Sasahara ⁵, Tomomi Kotani ⁶, Masahiro Hayakawa ⁷, Kiyoko Kato ⁸, Tomoaki Taguchi ⁹, Masayuki Endo ¹⁰, Haruhiko Sago ¹Affiliations expand

• PMID: 32989906
• DOI: 10.1111/jog.14504

Abstract

Aim: To present the feasibility, safety and outcomes of fetoscopic endoluminal tracheal occlusion (FETO) for the treatment of severe congenital diaphragmatic hernia (CDH).

Methods: This was a single-arm clinical trial of FETO for isolated left-sided CDH with liver herniation and Kitano Grade 3 stomach position (>50% stomach herniation into the right chest). FETO was performed at 27-29 weeks of gestation for cases with observed/expected lung to head ratio (o/e LHR) <25% and at 30-31 weeks for cases with o/e LHR ≥25%.

Results: Eleven cases were enrolled between March 2014 and March 2016, and balloon insertion was successful in all cases. The median o/e LHR at entry was 27% (range, 20-33%). The median gestational age at FETO was 30.9 (range, 27.1-31.7) weeks. There were no severe maternal adverse events. One fetus died unexpectedly at 33 weeks of gestation due to cord strangulation by the detached amniotic membrane. There were 3 cases (27%) of preterm premature rupture of membranes. In all 10 cases, balloon removal at 34-35 weeks of gestation was successful. The median gestational age at delivery was 36.5 (range, 34.2-38.3) weeks. The median duration of occlusion and the median interval between balloon insertion and delivery were 26 days (range: 17-49 days) and 43 days (range, 21-66 days), respectively. Both the survival rate at 90 days of age and the rate of survival to discharge were 45% (5/11).

Conclusion: The FETO is feasible without maternal morbidity in Japan and could be offered to women whose fetuses show severe isolated left-sided CDH to accelerate fetal lung growth.

Keywords: adverse events; congenital diaphragmatic hernia; fetal mortality; fetal therapy; fetoscopy.

© 2020 The Authors. Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.