Children's Hospital Colorado

Fetoscopy and Fetoscopic Endoluminal Tracheal Occlusion

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What is a fetoscopy?

Fetoscopy is a minimally invasive procedure where a fetal surgeon inserts a small instrument, called a fetoscope, into a pregnant woman's uterus under ultrasound guidance. A fetoscope allows a fetal surgeon to examine and perform procedures on the fetus during pregnancy.

Fetoscopy at the Colorado Fetal Care Center

Fetoscopy is an important component of treating many different fetal conditions and is used to perform fetal surgeries and collect biopsies. Our world-class fetal surgeons at the Colorado Fetal Care Center routinely utilize this technique when treating conditions like:

When treating a fetus diagnosed with CDH, a fetal surgeon will use a fetoscopy to visualize the fetus's airway and carefully place a balloon in a procedure called a fetoscopic endotracheal occlusion (FETO).

Fetoscopic endoluminal tracheal occlusion (FETO)

What is FETO?

Fetoscopic endoluminal tracheal occlusion (FETO) is a minimally invasive fetal surgery designed to accelerate a fetus's lung growth and development in fetuses that have severe congenital diaphragmatic hernia. In this surgery, a fetoscope is placed into the uterus and moved into the fetal trachea. Once in the trachea, a balloon is inserted to block off the trachea to promote lung growth so that a baby will be able to get enough oxygen after birth.

Studies suggest this innovative procedure may improve the outcomes of babies diagnosed with impaired lung development and conditions like severe left congenital diaphragmatic hernia (CDH).

Which conditions are treated with FETO?

Doctors use FETO to treat only the most severe cases of CDH that are diagnosed before the baby is born.

CDH is a birth defect that prevents a fetus's lungs from growing and developing normally. With CDH, the diaphragm fails to grow normally, leaving a hole in your unborn baby's diaphragm (the muscle that makes you breathe). This can cause organs from the abdomen to migrate into the chest, pushing the lungs and heart to the side and preventing the lungs from growing.

Why would my baby need FETO surgery before they're born?

If you're pregnant and your baby has been diagnosed with CDH, you may be a candidate for fetoscopic endoluminal tracheal occlusion.

In severe cases of CDH, babies are at risk for pulmonary hypoplasia (underdevelopment of the lungs), disease and death at birth. Studies suggest FETO improves the development of the fetal lung before the baby is born. Once your baby comes into the world, they may have improved postnatal lung function.

What happens during FETO?

If you're a candidate for FETO and decide upon this treatment option, you'll undergo up to two minimally invasive fetal procedures:

  • Balloon placement: Using ultrasound guidance, your fetal surgeon will insert a fetoscope into the uterus and then guide it into the fetus's mouth and then down the trachea (airway). Once in the trachea, they will maneuver a small, detachable balloon through the scope, inflate it with sterile saline and then detach it.

    Though fetuses do not need their lungs to breathe until birth, their lungs do need to grow. By blocking their airway with a balloon, we're able to prevent lung fluid from escaping the lungs. The collected fluid then creates a buildup of pressure that causes the lungs to expand. The procedure gives the lungs the time they need to grow.

  • Balloon removal: After several weeks, our fetal surgeons will remove the balloon from your unborn baby's airway so their lungs can mature. The process for balloon removal is similar to balloon placement. In some cases, the balloon can be removed at the same time as delivery.

What to expect with fetoscopic tracheal occlusion for CDH

The FETO procedure is performed at Children's Colorado's Colorado Fetal Care Center on Anschutz campus in our dedicated fetal operating room. Our specialized fetal center offers all of the specialized experts and equipment necessary to ensure the safety of you and your baby. Our maternal fetal anesthesiologists will be by your side the entire time to ensure the procedure is comfortable for you and your unborn baby with an epidural and IV sedation.

Once we've concluded the fetoscopic procedure, you will stay overnight so we can monitor you for any sign of contractions and monitor the wellbeing of the fetus. Following the procedure, you and your family will be asked to remain nearby until the baby is born. Unexpected delivery or complications after FETO surgery are risks that require monitoring and proper care.

Follow-up care for a FETO procedure

What's the recovery for a FETO procedure?

Because fetoscopic surgery is minimally invasive, the FETO procedure has a shorter recovery time than other surgeries.

Most mothers can go home after one night in the Colorado Fetal Care Center. We will ask you to remain close by for the rest of your pregnancy so we can regularly evaluate the progress of fetal lung growth and monitor for any complications.

How does FETO affect my delivery?

If there are any complications with the balloon following FETO surgery, some mothers may need to deliver via C-section, but a vaginal delivery is possible.

Why should I choose the Colorado Fetal Care Center for FETO?

Hearing that you and your child need a fetoscopic procedure can be scary, but knowing that you're in the hands of experts can relieve some of the worry. At the Colorado Fetal Care Center, we provide world-class care for mothers and their unborn babies. We offer fetoscopy and FETO surgery that improves outcomes for babies with congenital diaphragmatic hernia, twin-to-twin transfusion syndrome, amniotic band syndrome and more.

Our 24/7 care model means our fetal surgeons are always here to perform FETO surgery and to help deliver your child when the time comes. We offer some of the most advanced imaging capabilities in the country and are pioneering fetal interventions and treatments to advance the field of fetal surgery.

Additionally, Children's Colorado is also one of only a few children's hospitals in the nation with a dedicated labor and delivery unit. This means that mom and baby can stay together once the child is born.

Learn more about the Colorado Fetal Care Center and how we support families through diagnosis, treatment, recovery, delivery and care for their child.

For more information about fetoscopy or FETO

For questions about fetoscopy or the FETO procedure, call the Colorado Fetal Care Center at 855-313-3825.