Hello everyone! Continuing our Perinatal Pathology week is this article by Ellison, which showcases the FETO procedure. This new and unique procedure has helped saved many newborn lives, and we hope you enjoy reading about it!
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Before 1963, in-utero surgery was out of the question for those who had life-threatening fetal diseases or conditions. Soon after the development of in-utero surgery came the procedure Fetoscopic Endo Tracheal Occlusion or FETO. FETO gives a chance to those with Congenital Diaphragmatic Hernia.
Congenital Diaphragmatic Hernia, or CDH, is a condition affecting infants in which the diaphragm is underdeveloped, allowing parts of the chest and abdomen to collide, stunting prenatal lung growth. This can be life-threatening and leave the infant in an even more unstable condition around the time of birth.
There are 2 different types of CDH: Bockdalek and Morgagni Hernia. These 2 types of CDH are classified based on where the majority of the underdeveloped part of the diaphragm is located. Bockdalek CDH (approx. 95% of CDH cases) is identified by underdeveloped parts of the diaphragm on either side. In comparison, the much less common Morgagni CDH (approx. 5% of CDH cases) affects the front of the diaphragm.
Fetoscopic Endotracheal Occlusion, also known as FETO, is a procedure used to treat extreme cases of Bocdalek Congenital Diaphragmatic Hernia. During the FETO procedure, a device with a deflated balloon and a small camera is inserted inside the womb through a small incision. Then the device is carefully guided inside the fetus’s trachea where the balloon can be safely inflated. Once inflated, the balloon detaches itself from the device. Finally, the device is removed from the womb. This can all be supervised through the use of ultrasound in real-time.
It is important to note that at this point in the fetus’s life, it does not use its lungs to breathe. The placenta in the mother’s womb supplies all the oxygen (and nutrients) that the fetus needs to survive. In addition, the organs of the fetus experience rapid growth since they are not required to perform their function and develop simultaneously.
The procedure requires an extensive amount of time spent in the area of the hospital. The mother needs to be observed, especially while the fetus has the balloon in it. The balloon is removed only a few weeks before birth. This is done with the same steps as before, except a grasper is attached to the device in order to remove the balloon from the baby’s trachea. When birth occurs, the baby will be delivered to the Neonatal Intensive Care Unit (NICU). The NICU is a place in the hospital where infants and premature babies are monitored and may receive around-the-clock care in case of a medical emergency. The babies’ placement there, is a necessity because of their fragile condition from CDH.
In one study, the FETO procedure increased survival by 25% when compared to those who had undergone normal care. Mothers are also 46% more likely to have a preterm birth if FETO has been performed compared to those who do not have the procedure done.
It is important to note that the FETO procedure is still relatively new with approximately 215 procedures completed. Due to this, there are risks for both the mother and child. As a result, there are certain qualifications a mother must meet in order to go through with FETO. These qualifications change by the hospital, so it is hard to give any set-in-stone qualifications. The mother must realize this will be a challenging time, both physically and emotionally. Physically, if everything goes as planned, she must have 2 procedures in addition to the child’s birth. Emotionally, it may be challenging because of the nature of perinatal procedures. In most cases, the mother will be away from her home for months in order to be closer to the hospital. There are also chances that various complications can result from the procedure, which can put even more stress on her. Although there is only a 2% chance of having 2 children with CDH, this possibility may also be troubling to a mother.
Although the reasons one must undergo FETO are often heartbreaking, things are looking up.
As FETO is tested further, the accessibility of the procedure will increase. This development will help save future lives. A better world is out there, and it is our job to fight for it. Thank you.
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Thanks for reading the second article in our Perinatal Pathology series! We hope you learned about the importance and relevance of the FETO procedure in saving the lives of babies in the womb.
If you enjoyed reading this article, check out the first article in our Perinatal Pathology week, titled Just a Feeling. This article, by Salina Shafi, shows the job of a Perinatal Pathologist from the eyes of a couple that has suffered a miscarriage.
Until next time,
Ellison and the Writing Committee :)
The Children's Hospital of Philadelphia. “Fetoscopic Endoluminal Tracheal Occlusion (FETO).” Children's Hospital of Philadelphia, The Children's Hospital of Philadelphia, 23 July 2015, www.chop.edu/centers-programs/center-fetal-diagnosis-and-treatment/fetoscopic-endoluminal-tracheal-occlusion-feto.
“Fetal Endoscopic Tracheal Occlusion (FETO).” Fetal Endoscopic Tracheal Occlusion (FETO) | CS Mott Children's Hospital | Michigan Medicine, www.mottchildren.org/conditions-treatments/peds-fetal-medicine/fetal-endoscopic-tracheal-occlusion-feto.
“FETO.” Cincinnati Childrens, www.cincinnatichildrens.org/service/f/fetal-care/conditions/congenital-diaphragmatic-hernia/feto.
“Fetoscopic Endotracheal Occlusion (FETO): Johns Hopkins Center for Fetal Therapy.” Fetoscopic Endotracheal Occlusion (FETO) | Johns Hopkins Center for Fetal Therapy, 7 May 2019, www.hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/fetal_therapy/fetal-interventions-procedures/fetoscopic_tracheal_occlusion.html.
“Congenital Diaphragmatic Hernia.” Congenital Diaphragmatic Hernia | Vanderbilt Children's Hospital Nashville, TN, www.childrenshospitalvanderbilt.org/medical-conditions/congenital-diaphragmatic-hernia.
Van der Veeken, Lennart, et al. “Fetoscopic Endoluminal Tracheal Occlusion and Reestablishment of Fetal Airways for Congenital Diaphragmatic Hernia - Gynecological Surgery.” SpringerOpen, Springer, 8 May 2018, gynecolsurg.springeropen.com/articles/10.1186/s10397-018-1041-9.