Congenital diaphragmatic hernia: Can prenatal ultrasonography predict outcome?

Dommergues, Marc; Louis-Sylvestre, Christine; Mandelbrot, Laurent; Oury, Jean; Herlicoviez, M.; Body, G.; Gamerre, M.; Dumez, Yves

doi:10.1016/s0002-9378(96)70688-9

Cited by 82 publications

(68 citation statements)

References 11 publications

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“…Nevertheless, in our series, rightsided lesion as well as major mediastinal shift and herni- ated liver were more frequently observed in neonates who died before 7 days of life, and these factors have also been related to a poorer outcome in other studies. 1,5,7,16 By analyzing the natural history of CDH, the present study is important for demonstrating that each hospital may experience different neonatal mortality rates in isolated CDH. It also motivates us to review our neonatal care and our prenatal evaluation of prognosis as well as to consider fetal interventions in selected cases.…”

Section: Discussionmentioning

confidence: 99%

“…6 Nowadays, the mortality rate has been decreasing among neonates with isolated CDH, varying from 40% to 75% in developed countries. 1,7 Nevertheless, in spite of the great advances in prenatal and postnatal diagnosis and management, the mortality rate in neonates with isolated CDH is still high. 8 Recent research has focused on prenatal predictors of neonatal outcome in isolated CDH cases, such as lung/head ratio 9,10 and fetal lung volume, [11][12][13][14][15][16] to differentiate cases with a worse prognosis, in which fetal therapy or termination of pregnancy may be indicated, from those with better prognosis, requiring only specialized postnatal care.…”

Section: Introductionmentioning

confidence: 99%

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Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Ruano

Bunduki

Silva

et al. 2006

Clinics

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diagnosis and perinatal outcome of 38 cases with congenital diaphragmatic hernia: 8-year experience of a tertiary Brazilian center. Clinics. 2006;61(3):197-202. PURPOSE:To evaluate the perinatal results for neonates with congenital diaphragmatic hernia diagnosed prenatally. METHOD: We reviewed data from 38 cases of congenital diaphragmatic hernia diagnosed prenatally from January 1995 to December 2003 in the Fetal Medicine Unit of the Department of Obstetrics and Gynecology, São Paulo University Medical School. The main data analyzed were gestational age at diagnosis, fetal karyotyping, side of diaphragmatic defect, presence of associated structural malformations, hepatic herniation, and severe mediastinal shift. Perinatal outcomes were obtained by reviewing hospital documents or by directly calling the patients' immediate relatives. RESULTS: Mean gestational age at diagnosis was 29 weeks (range, 16-37 weeks).Thirty (79%) cases had a left diaphragmatic defect and 8 (21%) had a right lesion. Associated structural malformations were observed in 21 (55%) cases, in which 12 fetuses had a normal karyotype and 9 had chromosomal abnormalities. Isolated congenital diaphragmatic hernia was confirmed in 17 (45%) cases. The overall perinatal mortality rate was 92%. Rates of fetal deaths, early neonatal deaths, late neonatal deaths, and survival were 42%, 50%, 0%, and 8%, respectively, in cases with associated structural malformations but normal karyotyping; 56%, 44%, 0%, and 0% for cases with chromosomal abnormalities; and, 0%, 76%, 12%, and 12% in cases with isolated congenital diaphragmatic hernia. The neonatal mortality rate was 89% in cases with isolated congenital diaphragmatic hernia. CONCLUSION: Perinatal mortality was very high in prenatally diagnosed cases of congenital diaphragmatic hernia. Earlier perinatal deaths are associated with the presence of other structural defects or chromosomal abnormalities. In cases of isolated congenital diaphragmatic hernia, mortality is related to the presence of herniated liver, right-sided lesion, and major mediastinal shift.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Ruano

Bunduki

Silva

et al. 2006

Clinics

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“…Mediastinal deviation was considered major when no lung contralateral to the hernia could be imaged between the fetal heart and the thoracic wall on a 4-chamber view. 6 It was otherwise considered moderate. Fetal abdominal measurements were considered small when below the third percentile.…”

Section: Methodsmentioning

confidence: 99%

“…ongenital diaphragmatic hernia (CDH) diagnosed in utero has a neonatal mortality rate of 50% to 80%, [1][2][3][4][5][6][7] death being mainly due to pulmonary hypoplasia. Predicting the neonatal outcome prenatally remains a challenge.…”

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confidence: 99%

Evaluation of Fetal Pulmonary Vasculature by Power Doppler Imaging in Congenital Diaphragmatic Hernia

Michelet

Aubry

Sayed

et al. 2004

J of Ultrasound Medicine

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Objective. To evaluate the feasibility of prenatal power Doppler imaging of pulmonary arteries in congenital diaphragmatic hernia and to study its potential to predict outcome. Methods. A prospective observational study was conducted. Forty-two cases of congenital diaphragmatic hernia (32 left and 10 right) without associated anomalies were analyzed. Qualitative evaluation of pulmonary vasculature was based on power Doppler imaging performed at 26 to 38 weeks. The pulmonary arteries were studied in the lung contralateral to the hernia. Pulmonary Doppler angiography was considered satisfactory when 3 levels of bifurcation defining 3 distinct segments of the pulmonary arteries were imaged and was otherwise considered poor. We also recorded the gestational age at diagnosis, side of the hernia, abdominal circumference below the third percentile, amniotic fluid volume, lung/thoracic area ratio, left/right ventricle ratio, and, in left-sided hernias, stomach position, and we carried out a multivariate analysis to determine the contribution of each factor to predict neonatal mortality. Results. More than 3 divisions of the fetal pulmonary arteries were imaged in 20 cases; 1 or 2 divisions or none were imaged in 22. Neonatal mortality was significantly greater when fewer than 3 divisions of the pulmonary arteries were imaged (18 [82%] of 22) than when 3 divisions could be identified on power Doppler imaging (5 [25%] of 20; P = .0005). However, the lung/thoracic area ratio was the only factor that remained significantly associated with mortality in the multivariate analysis. Conclusions. An altered pulmonary power Doppler image is associated with neonatal mortality, but estimation of the lung area remains the best predictor of neonatal outcome. Key words: congenital diaphragmatic hernia; lung/head ratio; lung/thorax ratio; power Doppler imaging; prenatal diagnosis; pulmonary hypoplasia; sonography. ongenital diaphragmatic hernia (CDH) diagnosed in utero has a neonatal mortality rate of 50% to 80%, 1-7 death being mainly due to pulmonary hypoplasia. Predicting the neonatal outcome prenatally remains a challenge. Moreover, prenatal staging of CDH is becoming increasingly important as new intrauterine therapeutic interventions emerge, including minimally invasive fetal surgery.8 So far, research on prenatal prediction of pulmonary hypoplasia has focused on using sonography or magnetic resonance imaging to assess the size of the lungs, 7,9-14 the degree of herniation of abdominal organs, 6,15,16 and the consequences of fetal hemodynamic changes on left ventricular size. 17,18 In CDH, however, pulmonary hypoplasia is associated with alterations of the pulmonary vasculature, accounting for potentially lethal postnatal pulmonary hypertension.19

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“…Hydrops may occur more frequently in rightsided CDH because the venous returns are situated on the right side of the fetus. In the present case the prognosis was initially considered to be extremely poor due to the combination of negative outcome factors, which included time of diagnosis (22 weeks), a major portion of the liver being herniated into the chest, and the presence of hydrops and polyhydramnios 5 . However, the favorable prognostic factors included the absence of coexistent malformations and a normal karyotype.…”

Section: Right Diaphragmatic Hernia and Hydrops: Is It Always Fatal?mentioning

confidence: 93%

Right diaphragmatic hernia and hydrops: is it always fatal?

Shojai

Gire

Chaumoître

et al. 2004

Ultrasound in Obstet & Gyne

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Congenital diaphragmatic hernia: Can prenatal ultrasonography predict outcome?

Cited by 82 publications

References 11 publications

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Evaluation of Fetal Pulmonary Vasculature by Power Doppler Imaging in Congenital Diaphragmatic Hernia

Right diaphragmatic hernia and hydrops: is it always fatal?

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