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PubMed This is a summary of 4 peer-reviewed journal articles Updated
Maternal-Fetal Medicine

What is the FETO Procedure Timeline for CDH?

At a Glance

The FETO procedure for severe congenital diaphragmatic hernia (CDH) involves inserting a balloon into the fetal airway between 27 and 29 weeks of pregnancy to stimulate lung growth. It is scheduled for removal around 34 weeks, and must be removed before the baby takes its first breath.

In this answer

3 sections

01

When is the Balloon Placed?

02

When is the Balloon Removed?

03

What if the Baby Arrives Early?

The standard timeline for the FETO (Fetoscopic Endoluminal Tracheal Occlusion) procedure for severe congenital diaphragmatic hernia (CDH) involves placing a tiny balloon in the baby’s airway between 27 and 29 weeks of pregnancy, and removing it around 34 weeks [1]. The balloon must always be removed before the baby takes its first breath of air.

When is the Balloon Placed?

For severe cases of left-sided CDH, the balloon is typically inserted between 27 weeks 0 days and 29 weeks 6 days of pregnancy [1]. This timing gives the fetal lungs several weeks to benefit from the procedure. By blocking the airway, fluid normally produced by the lungs builds up, stretching and stimulating the lung tissue to grow faster before birth. Research has shown that inserting the balloon during this specific window significantly increases survival rates (from about 15% with standard care to 40% with FETO) for babies with severe left-sided CDH [1]. For moderate cases of CDH, placing the balloon later (between 30 and 32 weeks) has not been shown to provide the same survival benefits [2].

When is the Balloon Removed?

The scheduled time for balloon removal is between 34 weeks 0 days and 34 weeks 6 days of pregnancy [1].
It is absolutely critical that the balloon is removed or punctured before the baby can take its first breath. If the baby is born with the balloon still intact and blocking the airway, they will be unable to breathe, which is a life-threatening emergency [1]. By removing the balloon around 34 weeks, the baby’s airway is open and clear for delivery, while still allowing time for the lungs to mature further before birth.

What if the Baby Arrives Early?

While the goal is to reach 34 weeks, the FETO procedure increases the risk of premature birth and PPROM (preterm prelabor rupture of membranes, which is when your water breaks early) [1][3]. In fact, up to 75% of mothers who undergo FETO deliver prematurely [1].

Because of these risks, about 37% of balloons must be removed earlier than the planned 34-week mark due to early labor or the water breaking [1].

If early labor begins, doctors have emergency plans in place to retrieve the balloon. This can be done in the uterus, during a specialized delivery where the baby remains connected to the umbilical cord (often similar to an EXIT procedure), or immediately after birth by direct puncture [1]. Because early delivery is so common and requires immediate, specialized care, it is highly recommended that families relocate to stay very close to the specialized hospital during the weeks the balloon is in place [4].

Common questions in this guide

When is the FETO balloon inserted for CDH?
For severe left-sided congenital diaphragmatic hernia, the balloon is typically inserted between 27 and 29 weeks of pregnancy. This specific timing gives the fetal lungs several weeks to stretch, grow, and benefit from the blockage before birth.
When does the FETO balloon need to be removed?
The balloon is typically scheduled for removal between 34 weeks and 34 weeks and 6 days of pregnancy. It is absolutely critical that the balloon is removed or punctured before the baby takes its first breath of air.
What happens if I go into early labor with the FETO balloon still in?
Doctors have emergency protocols to remove the balloon if your water breaks or you go into early labor. Depending on the situation, it can be removed in the uterus, during a specialized delivery where the baby remains connected to the umbilical cord, or immediately after birth by direct puncture.
Does the FETO procedure cause premature birth?
Yes, the FETO procedure significantly increases the risk of your water breaking early and premature birth. In fact, up to 75 percent of mothers who undergo the FETO procedure deliver their babies prematurely.
Do I need to stay near the hospital after a FETO procedure?
Because early delivery is very common and requires immediate, specialized care to remove the balloon, it is highly recommended that families stay very close to the specialized hospital during the weeks the balloon is in place.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given my baby's specific measurements, what exact week do you recommend we schedule the balloon insertion?
  2. 2.If I go into preterm labor or my water breaks early, what is your team's exact protocol for emergency balloon removal?
  3. 3.During the weeks the balloon is in place, will I need to be admitted to the hospital, or can I stay at a nearby facility like a Ronald McDonald House?
  4. 4.Who will be performing the balloon removal procedure, and how many of these specific procedures have they performed?

Questions For You

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Related questions

Why Do CDH Survivors Need Multidisciplinary Clinics?Why Does CDH Cause Severe GERD and Feeding Issues?Will My Baby Outgrow Their CDH Patch? Risks & MonitoringCan CDH Surgery Be Done While on ECMO?Left vs. Right-Sided CDH: What Are the Differences?What is Gentle Ventilation for CDH?How Does Congenital Diaphragmatic Hernia Affect Lungs?CDH Liver Up vs Liver Down: What Does It Mean?Will My CDH Child Have Asthma or Need Oxygen?What Are the Prenatal Genetic Testing Options for CDH?How is Pulmonary Hypertension Treated in CDH Babies?Does CDH Affect Your Child's Chest & Spine Growth?What Causes CDH? Did I Cause My Baby's Hernia?What Happens in the Delivery Room with a CDH Baby?What to Expect When Your Baby is on ECMO for CDHWhy is CDH Surgery Delayed? The Role of Stabilization

References

References (4)
  1. 1

    Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia.

    Deprest JA, Nicolaides KH, Benachi A, et al.

    The New England journal of medicine 2021; (385(2)):107-118 doi:10.1056/NEJMoa2027030.

    PMID: 34106556
  2. 2

    Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia.

    Deprest JA, Benachi A, Gratacos E, et al.

    The New England journal of medicine 2021; (385(2)):119-129 doi:10.1056/NEJMoa2026983.

    PMID: 34106555
  3. 3

    Fetal endoscopic tracheal occlusion for moderate and severe congenital diaphragmatic hernia: a systematic review and meta-analysis of randomized controlled trials.

    Li Q, Liu S, Ma X, Yu J

    Pediatric surgery international 2022; (38(9)):1217-1226 doi:10.1007/s00383-022-05170-7.

    PMID: 35838786
  4. 4

    Prenatal Interventions for Congenital Diaphragmatic Hernia: A Systematic Review.

    Altala AS, Ahmed M, AlGhamdi AO, et al.

    Cureus 2025; (17(6)):e86502 doi:10.7759/cureus.86502.

    PMID: 40693055

This timeline is for educational purposes only and does not replace professional medical advice. Every pregnancy is unique, and you should discuss your specific FETO procedure schedule and risks with your maternal-fetal medicine specialist.

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