Congenital diaphragmatic hernia (CDH) occurs in a frequency of 1:2000 - 1:4000 live births and forms 8 % of all anomalies. Prognosis depends upon the lunt-to-head ratio (LHR), Observed-to expected LHR, Gestational age at delivery & Liver herniation.

Traditional management consists of expectant antenatal follow up, neonatal stabilization after birth and delayed surgical repair with survival of 50% of afflicted neonates.

FETO is a relatively new procedure in which a 1.2 mm endoscope is passed into the fetal trachea through the maternal uterine wall, and a balloon is inflated and placed in the fetal trachea. This prevents egress of fluid from fetal lungs, and reduces the degree of pulmonary hypoplasia. This balloon is removed after birth by the EXIT (Ex-utero Intrapartum Technique) or by percutaneous puncture antenatally or postnatally.

Preliminary results with FETO are promising, especially in fetuses with poor prognosis (i.e. those with liver herniation and LHR <1) who do poorly with expectant management. However, some unresolved issues remain such as Ideal gestational age, Inclusion criteria, Follow-up, Neoatal management, Training in EXIT procedures and Prognostication of survival in treated fetuses.