Congenital diaphragmatic hernia. In utero therapy and ethical considerations

Despite advances in neonatal medicine, the mortality rate for congenital diaphragmatic hernia remains high. The results of work in animal models suggest that this anomaly may be amenable to in utero surgical correction. In this article, the natural history of congenital diaphragmatic hernia in humans is reviewed, and the development of antenatal management strategies is traced. The ethical issues surrounding the management of fetuses with diaphragmatic hernias are also discussed. The ground-breaking nature of the development of strategies for management of congenital diaphragmatic hernia underscores the importance of establishing scientific and ethical guidelines for future endeavors with in utero therapy.