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Congenital diaphragmatic hernia: prenatal evaluation and outcome
Author(s) -
Masini L.,
De Santis M.,
Noia G.,
Milej B.,
Cavaliere A. F.,
Romagnoli C.,
Perrelli L.,
Caruso A.
Publication year - 2001
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.1469-0705.2001.abs23-8.x
Subject(s) - medicine , polyhydramnios , prenatal diagnosis , trisomy , congenital diaphragmatic hernia , hernia , diaphragmatic hernia , gestational age , obstetrics and gynaecology , surgery , obstetrics , incidence (geometry) , pulmonary hypoplasia , pregnancy , fetus , pediatrics , genetics , physics , optics , biology
Objectives: • To describe the incidence of congenital diaphragmatic hernia (CDH). • To describe the hernia type (right, left, eventration), the gestational age at diagnosis, the associated anomalies and chromosomal disorders. • To describe the perinatal outcome and the pre‐ and postoperative mortality rate.Material and methods: A total of 51 fetuses and babies with congenital diaphragmatic hernia or eventration (referred to collectively as CDH) were studied at Dept. Obstetrics and Gynecology, Università Cattolica di Roma, in the 20‐year period from 1981 to 2001. Results: Prenatal diagnosis was made in 48 cases (17 were diagnosed before 26 weeks, 31 between 27 and 40 weeks), two cases were diagnosed in the neonatal period and one case at the postmortem analysis. The most common hernia was left‐sided (38 cases); six cases were right‐sided; four cases had eventration; four cases had complex anomaly with exomphalos and ectopia cordis (suspicious Cantrell's pentalogy). Twenty‐three fetuses had associated anomalies, including four chromosomal disorders (trisomy 18 in two cases, trisomy 13 in one and unbalanced translocation in one). Polyhydramnios was present in 20 fetuses. Perinatal outcome: Two patients had termination of pregnancy in other institutions; 44 patients delivered (36 cesarean section and 8 vaginal delivery); 2 pregnancies are still ongoing and 3 patients (early diagnosis) have no follow up. Out of the 44 live births, 16 died before surgery and 28 underwent surgical repair. Fifteen early postoperative deaths occurred. Conclusions: The overall survival in babies with CDH is very poor, despite multidisciplinary management, mainly for associated anomalies. A careful ultrasound survey may suggest which fetuses have an isolated diaphragmatic defect and a better prognosis.