What to Expect Before Your Baby is Born

CDH is often diagnosed before a baby is born during a routine ultrasound in the second trimester of pregnancy. The fetal ultrasound may show abdominal organs in the chest or an increased amount of amniotic fluid, which may be caused by fetal lung abnormalities.

In some cases, a CDH may not be detected until after the baby is born.

If a CDH is diagnosed during pregnancy, you may be referred to a fetal center for comprehensive evaluation and specialized care.

At Texas Children’s Hospital, we arrange for you to visit as quickly as possible to meet with our team of specialists, experiences in treating CDH. Our team includes providers who will care from you from the time of your diagnosis, through delivery and in the long-term, including pediatric surgeons, maternal-fetal medicine physicians, neonatologists, genetic counselors, and fetal imaging experts.


Prenatal Evaluation

Testing may include:

We use measurements from your prenatal imaging to look at how severe your baby’s CDH is:

  • Fetal lung-to-head ratio (LHR)
  • Liver herniation into the chest – we will look at the position of the liver and see if any of the liver has pushed into the chest. Larger defects tend to have more liver herniated into the chest.
  • Total fetal lung volume – we measure how much lung your baby from your fetal MRI

At the end of the day, we will meet with you to go over your results. Based on the needs of your baby, we will help you make the most informed decisions for care and treatment.


Fetal Surgery for CDH

When a baby has severe CDH, our team may offer an experimental fetal surgery known as Fetal Endoscopic Tracheal Occlusion (FETO). FETO may be an option to potentially improve lung growth before birth. The Texas Children’s CDH Program is one of the few centers in the nation to offer FETO. We offer one of the most skilled and experienced team of physicians in this treatment.

The Texas Children’s Fetal Center is also one of the few programs in the country with permission from the U.S. Food and Drug Administration (FDA) for the moderate TOTAL (Tracheal Occlusion To Accelerate Lung Growth) trial, a pilot studying of FETO for moderate cases of CDH.

FETO is a minimally invasive procedure where a small camera, about the size of a straw, is inserted through a small incision through the mother’s abdomen and into the uterus. A small inflatable balloon is placed into the fetal trachea to temporarily block the airway.

Blocking the fetal trachea allows fluid to build up in the lungs with the goal of promoting growth and development during the remainder of the pregnancy. The balloon is removed before delivery, often around 34 weeks gestation.

After delivery, surgery can be performed to close the hole in the diaphragm.

Because the FETO procedure temporarily blocks the baby’s airway, unexpected delivery can be life-threatening. The mother must remain near the fetal center for close monitoring and follow-up throughout the pregnancy, with immediate access to specialized care in case of preterm delivery.

At Texas Children’s, our CDH FETO team is on standby 24/7 for when our patients need us.