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Three‐dimensional ultrasonographic measurements of the fetal lungs for prediction of perinatal outcome in isolated congenital diaphragmatic hernia
Author(s) -
Ruano Rodrigo,
Aubry MarieCécile,
Barthe Bruno,
Dumez Yves,
Benachi Alexandra
Publication year - 2009
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/j.1447-0756.2009.001060.x
Subject(s) - medicine , congenital diaphragmatic hernia , pulmonary hypoplasia , fetus , lung , diaphragmatic hernia , diaphragmatic breathing , hypoplasia , obstetrics , lung volumes , hernia , cardiology , pregnancy , surgery , pathology , genetics , alternative medicine , biology
Aim: To evaluate the potential of different lung measurements using three‐dimensional ultrasonography (3D‐US) to predict perinatal outcome in isolated congenital diaphragmatic hernia (CDH). Methods: Twenty‐one fetuses presenting isolated CDH were prospectively evaluated by 3D‐US between January 2002 and November 2003. Observed/expected total, contralateral and ipsilateral fetal lung volume ratios (o/e‐TotFLV, o/e‐ContFLV and o/e‐IpsiFLV, respectively) were calculated using the rotational technique and ultrasonographic fetal total lung volume to bodyweight ratio (USFLW). These lung measurements were compared to each other and to perinatal outcomes: perinatal deaths, severe pulmonary hypoplasia (PH) and pulmonary arterial hypertension (PAH). Results: Perinatal death occurred in 11 of the 21 infants (52.4%), severe PH in 14 of 21 infants (66.7%) and PAH in 14 of 20 neonates (70%). Severe PH and PAH occurred simultaneously in 12 of 20 (60%) infants. Good correlations between lung ratios were observed. O/e‐TotFLV, o/e‐IpsiFLV and USFLW correlated statistically with postnatal diagnosis of severe PH, while only o/e‐TotFLH correlated statistically with postnatal diagnosis of PAH. The accuracies of o/e‐TotFLV, o/e‐ContFLV, o/e‐IpsiFLV and USFLW in predicting perinatal deaths were 85.7, 76.2, 66.7 and 76.2%, respectively. Conclusion: O/e‐TotFLV using 3D‐US appears to be the most accurate predictor of perinatal mortality because it can predict both PH and PAH.