Altala Abdulaziz S, Ahmed Mohayad, AlGhamdi Ahmed O, Alroudhan Fares, Alqahtani Rakan A, Alanazi Faisal, Alshahrani Khalid A, Alruwili Zain Amer, Oberi Imtenan A, Alqahtani Alhanouf, N Alamri Amal, Binyamin Judy, Alzahrani Manar, F Alzebali Abdullah, AlFaifi Khaled H
Department of Basic Medical Sciences, College of Medicine, Dar Al Uloom University, Riyadh, SAU.
Department of Anatomy, Nile University, Khartoum, SDN.
Cureus. 2025 Jun 21;17(6):e86502. doi: 10.7759/cureus.86502. eCollection 2025 Jun.
Life-threatening congenital diaphragmatic hernia (CDH) is a defect with subsequent herniation of abdominal organs. Herniation of abdominal organs into the thoracic cavity causes pulmonary hypoplasia and hypertension. Despite improved baby critical care and surgical therapy, severe CDH has high mortality and morbidity rates. The prenatal intervention of fetoscopic endoluminal tracheal occlusion (FETO) has become popular for improving postnatal survival and lung development. However, its efficacy in reducing maternal risks, morbidity, and improving newborn survival is still debated. This systematic study compares FETO with expectant management of mothers on neonatal and maternal outcomes. A PICO-based systematic review was conducted. The study included fetuses with severe or moderate CDH. The intervention group had FETO, while the control group had expectant management with postnatal surgery. Neonatal survival, morbidity, and maternal problems were evaluated. A complete PubMed, OpenAlex, and CENTRAL search yielded 669 records. Forty papers met Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) eligibility criteria after deleting 154 duplicates, screening 515 abstracts, and analyzing 102 full-text articles. RCTs, cohort studies, and retrospective analyses were conducted. The data were extracted after title and abstract screening, followed by full-text screening using inclusion and exclusion criteria. Statistical analyses were then performed using RStudio (Posit PBC, Boston, MA, USA) to assess morbidity patterns, maternal risk factors, and pooled survival rates. Pooled analyses suggest that FETO may be associated with improved survival in severe CDH cases with liver herniation compared to expectant management. Some studies report noticeably higher survival rates with FETO, though others have shown the opposite trend, possibly reflecting differences in patient selection criteria. FETO has also been associated with higher incidences of pulmonary hypertension, prolonged ventilatory support, and increased risk of gastrointestinal complications such as feeding difficulties, gastroesophageal reflux, and reherniation. The impact of FETO on extracorporeal membrane oxygenation requirements appears inconsistent across studies, with some indicating a reduced need and others reporting similar rates regardless of intervention. A notable concern with FETO is its association with increased risks of preterm premature rupture of membranes (PPROM) and preterm delivery. PPROM has been reported in nearly half of FETO cases, compared to lower rates in expectant management. Correspondingly, gestational age at delivery tends to be earlier in FETO pregnancies, potentially contributing to lower birth weights and higher rates of neonatal intensive care unit admission. Serious maternal complications, such as hemorrhage, sepsis, or organ injury, are infrequently reported. FETO improves survival in severe CDH cases; however, this systematic analysis demonstrates that treatment increases neonatal morbidity and maternal morbidity. The findings highlight the importance of precise patient selection to maximize benefits and minimize risks. Clinically, FETO should be reserved for severe CDH cases in which the survival benefits outweigh the problems. Future research should focus on standardizing FETO procedures, enhancing postnatal care, and investigating other therapies to reduce PPROM and preterm birth risk.
危及生命的先天性膈疝（CDH）是一种伴有腹部器官随后疝出的缺陷。腹部器官疝入胸腔会导致肺发育不全和高血压。尽管婴儿重症监护和手术治疗有所改善，但严重的CDH仍有很高的死亡率和发病率。胎儿镜下腔内气管阻塞（FETO）的产前干预已因改善出生后存活率和肺发育而受到欢迎。然而，其在降低母亲风险、发病率以及提高新生儿存活率方面的疗效仍存在争议。这项系统研究比较了FETO与对母亲进行期待性管理对新生儿和母亲结局的影响。进行了一项基于PICO的系统评价。该研究纳入了患有重度或中度CDH的胎儿。干预组接受FETO，而对照组接受产后手术的期待性管理。评估了新生儿存活率、发病率和母亲问题。对PubMed、OpenAlex和CENTRAL进行全面检索共得到669条记录。在删除154条重复记录、筛选515篇摘要并分析102篇全文文章后，有40篇论文符合系统评价与Meta分析的首选报告项目（PRISMA）资格标准。进行了随机对照试验、队列研究和回顾性分析。在标题和摘要筛选后提取数据，随后使用纳入和排除标准进行全文筛选。然后使用RStudio（美国马萨诸塞州波士顿的Posit PBC公司）进行统计分析，以评估发病模式、母亲风险因素和合并存活率。汇总分析表明，与期待性管理相比，FETO可能与肝疝出的严重CDH病例存活率提高有关。一些研究报告FETO的存活率明显更高，不过其他研究显示了相反的趋势，这可能反映了患者选择标准的差异。FETO还与肺动脉高压、通气支持时间延长以及胃肠道并发症（如喂养困难、胃食管反流和再疝出）风险增加有关。FETO对体外膜肺氧合需求的影响在各研究中似乎不一致，一些研究表明需求减少，而另一些研究报告无论干预如何发生率相似。对FETO的一个显著担忧是它与胎膜早破（PPROM）和早产风险增加有关。在近一半的FETO病例中报告了PPROM，而期待性管理中的发生率较低。相应地，FETO妊娠的分娩孕周往往更早，这可能导致出生体重较低和新生儿重症监护病房收治率较高。很少报告严重的母亲并发症，如出血、败血症或器官损伤。FETO可提高严重CDH病例的存活率；然而，这项系统分析表明，该治疗会增加新生儿发病率和母亲发病率。研究结果强调了精确选择患者以最大化益处并最小化风险的重要性。临床上，FETO应保留用于生存益处超过问题的严重CDH病例。未来的研究应专注于规范FETO程序、加强产后护理以及研究其他疗法以降低PPROM和早产风险。
