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Prenatal diagnosis and perinatal outcome in congenital diaphragmatic hernia. Single tertiary center report.
[congenital diaphragmatic hernia]
To
evaluate
the
perinatal
results
for
fetuses
and
neonates
with
left-sided
congenital
diaphragmatic
hernia
(
CDH
)
and
the
role
of
the
prenatal
diagnosis
in
the
pregnancy
outcome
.
We
reviewed
data
from
fetuses
and
neonates
with
left-sided
CDH
,
managed
from
January
2009
and
December
2013
in
the
University
Clinic
Hospital
,
Craiova
,
Romania
.
The
following
data
were
analyzed
:
the
gestational
age
at
the
time
of
diagnosis
,
fetal
karyotyping
,
presence
of
associated
structural
malformations
,
ultrasound
(
US
)
data
(
circumference
and
area
of
right
lung
,
lung
-
to
-
head
ratio
-
LHR
,
observed
รท
expected
LHR
,
hepatic
herniation
)
,
the
type
of
antenatal
care
,
the
pregnancy
outcome
,
the
place
of
birth
and
the
conventional
autopsy
data
,
if
performed
.
Perinatal
outcomes
were
obtained
by
reviewing
hospital
documents
.
Twenty
-
one
cases
were
identified
.
No
fetal
surgery
was
performed
in
our
series
.
Mean
gestational
age
at
time
of
diagnosis
was
29
weeks
of
amenorrhea
(
WA
)
(
range
,
16
-
37
WA
)
.
Associated
structural
malformations
were
noticed
in
nine
(
42
.
8
%
)
cases
,
in
which
three
fetuses
had
a
normal
karyotype
and
two
had
chromosomal
abnormalities
,
and
four
fetuses
were
not
investigated
.
Isolated
congenital
diaphragmatic
hernia
was
confirmed
in
12
(
57
.
1
%
)
cases
.
All
early
second
trimester
diagnosed
cases
were
terminated
.
The
overall
mortality
rate
was
61
.
9
%
.
Rates
of
fetal
deaths
,
early
neonatal
deaths
,
late
neonatal
deaths
,
and
survival
were
28
.
5
%
,
19
%
,
14
.
2
%
,
and
38
%
,
respectively
.
The
perinatal
mortality
rate
was
19
%
in
cases
with
isolated
congenital
diaphragmatic
hernia
.
The
overall
and
perinatal
mortality
rate
in
congenital
diaphragmatic
hernia
was
still
high
in
our
series
.
Early
perinatal
deaths
are
associated
with
early
diagnosis
and
with
the
presence
of
other
structural
defects
.
The
prevalence
of
chromosomal
abnormalities
in
perinatal
death
could
not
be
determined
from
these
data
.
In
isolated
congenital
diaphragmatic
hernia
,
mortality
is
related
to
the
presence
of
herniated
liver
and
severe
pulmonary
hypoplasia
,
this
being
well
correlated
with
antenatal
ultrasound
parameters
used
for
the
estimation
of
fetal
lung
volumes
.
The
antenatal
diagnosis
allowed
better
counseling
of
the
parents
,
description
of
associations
and
improving
the
neonatal
care
.
Diseases
Validation
Diseases presenting
"neonatal care"
symptom
congenital diaphragmatic hernia
dystrophic epidermolysis bullosa
harlequin ichthyosis
lamellar ichthyosis
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