• Survival to discharge from hospital [ Time Frame: Days to discharge ] [ Designated as safety issue: No ]
• Maternal morbidity [ Time Frame: Until maternal discharge ] [ Designated as safety issue: Yes ]
• Fetal / Neonatal morbidity [ Time Frame: Overall & at discharge from hospital ] [ Designated as safety issue: Yes ]
• Premature preterm rupture of membranes [ Time Frame: Following the interventions over the remainder of gestation ] [ Designated as safety issue: Yes ]
• Unintended preterm delivery [ Time Frame: Following the interventions before scheduled elective delivery ] [ Designated as safety issue: Yes ]
• Days in intensive care [ Time Frame: Number of day until discharge from ICU ] [ Designated as safety issue: Yes ]
• Days in hospital [ Time Frame: Number of days until discharge from hospital ] [ Designated as safety issue: Yes ]
• Oxygen dependency on discharge [ Time Frame: Days until discharge ] [ Designated as safety issue: Yes ]

• Survival to discharge from hospital
• Maternal morbidity
• Fetal morbidity
• Premature preterm rupture of membranes
• Unintended preterm delivery
• Days in intensive care
• Days in hospital
• Oxygen dependency on discharge

Left diaphragmatic hernia detected during fetal life carries a high risk for postnatal lung failure due to lung underdevelopment and pulmonary hypertension. In severe cases, extracorporeal membrane oxygenation (ECMO) is used as a life-saving intensive care means to enable survival of severely affected infants.

Clinical experience from prospective controlled non-randomized case series with fetoscopic tracheal balloon occlusion has seen improved survival rates in contrast to untreated controls.

Therefore, the purpose of this randomized clinical trial in a less severely affected subgroup of patients is whether by fetoscopic tracheal occlusion, the intensity of postnatal intensive care therapy might be reduced. Primary outcome measure is the need for postnatal ECMO therapy.

Inclusion Criteria:

• Pregnant women from European countries carrying fetuses with left diaphragmatic hernia.
• Normal karyotype, no further severe anomalies on prenatal ultrasound study.
• Fetal liver herniation into the chest; gestational age-related lung volume between 20-25% of normal as determined by magnetic resonance imaging between 30+0 - 34+0 weeks+days of gestation.

Exclusion Criteria:

• Any maternal disease or condition that would result in an increased risk to her health from the experimental procedure.
• Abnormal fetal karyotype, further severe fetal anomalies on prenatal ultrasound.