Which Treatment for Congenital Diaphragmatic Hernia Diagnosed in Utero?
Congenital diaphragmatic hernia in fetuses can be diagnosed by ultrasound early in pregnancy. Rates of postnatal mortality are high for fetuses with liver herniation and low lung-to-head ratios, because the lungs aerate poorly after birth. Given that the underlying pathogenesis is pulmonary hypoplasia, various strategies have been used to augment hypoplastic lungs in utero. The current surgical strategy for promoting fetal lung growth is to prevent egress of lung fluid by occluding the fetal trachea. A team at the University of California at San Francisco (the center with the world’s longest experience in fetal surgery) conducted a randomized, controlled trial to determine whether fetal endoscopic tracheal occlusion is more efficacious than expectant treatment followed by surgery immediately after birth (standard care). The trial involved 24 women whose fetuses (mean gestational age, 25 weeks; range, 22-27 weeks) had severe left-sided congenital diaphragmatic hernia (unfavorable lung-t
