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P33Fetal diaphragmatic hernia: our experience of 43 cases
Author(s) -
Galindo A.,
Arbues J.,
Puente J. M.,
Cano I.,
De La Fuente P.
Publication year - 2000
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2000.00004-1-33.x
Subject(s) - medicine , polyhydramnios , incidence (geometry) , diaphragmatic hernia , gestational age , diaphragmatic breathing , congenital diaphragmatic hernia , hernia , prenatal diagnosis , surgery , gastroenterology , pregnancy , pediatrics , gestation , fetus , alternative medicine , pathology , optics , biology , genetics , physics
Aim To review our experience with diaphragmatic hernia (DH). Methods We review retrospectively 43 cases prenatally diagnosed and 7 postnatally between January 1990 and November 1999. Results The incidence was 1/1496 deliveries. Sensitivity was 86%. Mean gestational age at diagnosis was 29 weeks. In 15 cases (38%), diagnosis was ≤ 22 weeks; perinatal mortality rate (PMR) in these did not differ significantly from that in cases of later diagnosis (80% vs. 50%). In 36 cases (83.7%) there was left‐sided DH and in 7 cases (16.3%) was right‐sided without differences in PMR (58.3% vs. 71.4%). In 17 cases (39.5%) associated anomalies were observed; PMR was significantly higher than in isolated cases (94.1% vs. 38.5%). In 14 cases (32.5%) liver herniation was noted; PMR was also significantly higher than in cases without herniation (78.6% vs. 51.7%). The incidence of polyhydramnios was 30% (13/43); differences in PMR between subgroups were statistically significant (76.9% vs. 16.7%). A pseudohypoplasia of the left heart was observed in 9 cases (20.1%); PMR was significantly higher than the observed in cases without it (77.8% vs. 55.9%). Mean weight of the newborns was 2435 g. The PMR in cases < 2500 g was significantly higher than in newborns > 2500 g (75% vs. 26.3%). Overall PMR in cases prenatally diagnosed was 60.5% and in those postnatally diagnosed was 43% (not statistically significant). Considering only prenatally diagnosed isolated cases, the survival rate rose to 65.3% and excluding terminations of pregnancy to 85%. Conclusion The prognosis of DH largely depends on the existence of associated defects but there are several prognostic factors associated with a worse outcome. However isolated cases may have a favourable outcome with ‘classical’ management.