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Three‐dimensional ultrasonographic assessment of fetal lung volume as prognostic factor in isolated congenital diaphragmatic hernia
Author(s) -
Ruano Rodrigo,
Benachi Alexandra,
Joubin Laurence,
Aubry MarieCécile,
Thalabard JeanChristophe,
Dumez Yves,
Dommergues Marc
Publication year - 2004
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2004.00100.x
Subject(s) - congenital diaphragmatic hernia , medicine , pulmonary hypoplasia , gestational age , lung volumes , lung , fetus , diaphragmatic hernia , diaphragmatic breathing , confidence interval , surgery , hernia , pregnancy , pathology , genetics , alternative medicine , biology
Objective To evaluate the potential of three‐dimensional ultrasound to predict outcome in congenital diaphragmatic hernia. Design Prospective observational study. Setting Tertiary care centre. Population Twelve cases of isolated congenital diaphragmatic hernia (11 left‐sided, 1 right‐sided) and 109 controls. Methods Fetal lung volume was assessed by three‐dimensional ultrasound using the technique of rotation of the multiplanar imaging. In the control fetuses, a logistic transformation was performed to correlate fetal lung volume with gestational age, and the confidence interval was obtained with a bootstrap resampling. A mathematical equation was then obtained allowing calculation of the expected fetal lung volume as a function of gestational age. In fetuses with congenital diaphragmatic hernia, the observed/expected lung volume ratio was compared with postnatal outcome. Main outcome measures Neonatal mortality and pulmonary hypoplasia, which was defined as lung/body weight ratios less than 0.012. Results The expected fetal lung volume was derived from the mathematical equation: Fetal lung volume (mL) = exp (4.72/(1 + exp ((20.32 − gestational age in weeks)/6.05))). The observed/expected fetal lung volume ratio was significantly lower in the congenital diaphragmatic hernia group (median: 0.34, range: 0.16–0.66), than in the control group (median: 1.02, range: 0.62–1.97, P < 0.0001). The distribution of this ratio was significantly downshifted in the infants with congenital diaphragmatic hernia who died (median: 0.19, range: 0.18–0.66) compared with survivors (median: 0.44, range: 0.36–0.66, P = 0.04). The observed/expected fetal lung volume ratio was also correlated with the postmortem lung/body weight ratio. Conclusion In isolated congenital diaphragmatic hernia, fetal lung volume measurement by three‐dimensional ultrasound is a potential predictor for pulmonary hypoplasia and postnatal outcome.