Have the results of the TOTAL-trials changed the attitude and practice of maternal-fetal medicine specialists?

ObjectiveTo explore the views and practices of maternal-fetal medicine specialists on offering fetoscopic endoluminal tracheal occlusion (FETO) for left- and right-sided congenital diaphragmatic hernia (LCDH, RCDH) in the post Tracheal Occlusion To Accelerate Lung growth (TOTAL)-trial era. MethodCross-sectional knowledge, attitude and practice survey was conducted among 105 attendees of the 19th World Congress of Fetal Medicine. ResultsOn average, respondents were knowledgeable about CDH, involved in research, and provided antenatal treatment options. Four out of five (82%) agreed that neonatal survival in LCDH can be reliably predicted in the prenatal period. Few respondents considered the exact risks and benefits of FETO for severe LCDH as being unclear (16%), yet half were uncertain about this for moderate LCDH (57%) and severe RCDH (45%). Most respondents offer FETO for severe LCDH (97%) and RCDH (79%), but only 59% offer it for moderate LCDH. However, half of respondents (58%) stated that not offering FETO for moderate LCDH would be a psychological burden for parents. ConclusionRespondents consider the risk-benefit ratio of FETO for severe LCDH clear and consistently offer FETO, but not for moderate LDCH and severe RCDH. However, not offering the option of FETO to parents was considered a psychological burden.

Automated summary

The survey shows that most maternal-fetal medicine specialists consider the risk-benefit ratio of FETO for severe LCDH and RCDH clear and often offer this treatment option. However, they are uncertain about the risks and benefits of FETO for moderate LCDH and severe RCDH, and therefore do not frequently offer this option. However, not offering FETO to parents is considered a psychological burden.