Premium
Longitudinal changes in lung size and intrapulmonary‐artery Doppler during the second half of pregnancy in fetuses with congenital diaphragmatic hernia
Author(s) -
CruzMartinez Rogelio,
MartínezRodríguez Miguel,
NietoCastro Belén,
GámezVarela Alma,
CruzLemini Monica,
LunaGarcía Jonahtan,
JuárezMartínez Israel
Publication year - 2019
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5401
Subject(s) - congenital diaphragmatic hernia , medicine , fetus , pregnancy , cardiology , lung , gestation , odds ratio , genetics , biology
Objectives The objectives of the study are to evaluate longitudinal changes in lung size and intrapulmonary‐artery (IPa) Doppler in fetuses with congenital diaphragmatic hernia (CDH) and assess their contribution in predicting neonatal survival. Methods The observed/expected lung‐to‐head ratio (O/E‐LHR) and IPa–pulsatility index (PI) and peak early diastolic reversed flow (PEDRF) were evaluated in a cohort of left‐sided CDH fetuses managed expectantly during pregnancy. Longitudinal changes were analyzed by multilevel analysis, and their value to predict survival using the multiple logistic regression and decision‐tree analysis was assessed. Results A total of 232 scans were performed on 69 CDH fetuses. The O/E‐LHR values remained unchanged during fetal monitoring, whereas IPa–PI and PEDRF showed a progressive increase throughout follow‐up, becoming abnormal on average at 30 weeks of gestation. Absent/reversed end‐diastolic velocity (EDV) in the IPa was observed in 20.3%. O/E‐LHR and IPa Doppler indices were significantly associated with probability of survival (O/E‐LHR ≥ 26%, odds ratio [OR] 19.0; IPa–PI <+2.0 z score, OR 3.0; and positive EDV, OR 7.4). All cases with IPa‐reversed EDV died after birth. Conclusion While lung size remains stable during pregnancy, CDH fetuses show progressive deterioration in intrapulmonary blood flow. IPa Doppler evaluation may aid in predicting survival of CDH fetuses managed expectantly during pregnancy.