Miracle Surgery Within the Womb

March 2022

Audrey Chan

A fetus presents with a hole in the diaphragm muscle during the second-trimester ultrasound. The intestines, stomach, and liver compress into the chest cavity, crowding the lungs and hindering fetal lung growth. Babies with this issue, congenital diaphragmatic hernia (CDH), have a meager 15-20% chance of survival. With the fetoscopic endoluminal tracheal occlusion (FETO) procedure, however, survival rates can be boosted to up to 50%.

In normal fetal development, a fetus’s lungs naturally produce a fluid that fills the trachea (windpipe) to stimulate lung development. A fetus diagnosed with CDH has impaired lung development since the organs from the lower abdominal cavity fill the space designated for the lungs. FETO is an artificial method that recreates the natural blocking of the trachea and stimulates the development of lung growth.

In a FETO procedure, a small incision is made in the mother’s belly and uterus. A small instrument, the fetoscope, is inserted through the incision and into the baby’s trachea. With the fetoscope, a small balloon is inserted and inflated into the trachea, blocking it and stimulating lung growth. The balloon stays in the baby’s trachea for 4-6 weeks before a second procedure is performed to remove the balloon.

The mother will undergo several ultrasounds between the first and second procedures to monitor the baby’s condition. Similar to the first procedure, a small incision is made and a fetoscope enters through the incision and into the baby’s trachea. This time, however, the balloon is deflated, allowing the baby’s lungs to continue to grow.

FETO was developed by Dr. Kypros Nicolaides, a British fetal medicine surgeon. He has done this procedure over 2,000 times and has raised the survival rate of fetuses with CDH from 15-20% to 50%. “There is no better reward in life than a woman coming along to show you her baby,” he says, “and sending photographs to say: ‘Thank you, this baby would not have been born.’ How can you judge that? Against what? That is the ultimate reward.”

References

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The Johns Hopkins Center for Fetal Therapy. “Fetoscopic Tracheal Occlusion Procedure for Congenital Diaphragmatic Hernia (CDH).” Johns Hopkins Medicine, 7 May 2019, www.hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/fetal_therapy/fetal-interventions-procedures/fetoscopic_tracheal_occlusion.html.

Davies, Caroline. “Surgery in the Womb: Miracle Maker for NHS’s Tiniest Patients.” The Guardian, 29 Nov. 2017, www.theguardian.com/society/2016/jan/29/surgery-in-womb-man-making-miracles-nhs-patients-babies-in-utero-kypros-nicolaides.

Cincinnati Children’s Fetal Care. “Fetoscopic Endoluminal Tracheal Occlusion (FETO) to Treat CDH.” Cincinnati Children’s, www.cincinnatichildrens.org/service/f/fetal-care/conditions/congenital-diaphragmatic-hernia/feto. Accessed 6 Aug. 2022.