Diaphragmatic Hernias Complicating Pregnancy

Abstract

Diaphragmatic hernias can cause life-threatening complications in pregnancy. Consideration should be given to operative repair in the second trimester if asymptomatic hernias are identified during pregnancy. If vaginal delivery is attempted in the presence of a hernia, this should only be carried out under closely monitored conditions.

An Unusual Cause of Maternal Respiratory Distress in Postoperative-Postpartum Period: Diaphragmatic Hernia

“…There is a consensus that a surgical emergency and operative management is necessary irrespective of fetal maturity when hernias diagnosed in the late stage. But elective management of asymptomatic hernias is controversial (8). In traditional approach it is recommended that immediate repair is essential for symptomatic patients because further delay may result in maternal and fetal death (9).…”

Bochdalek Diaphragmatic Hernia Complicating Pregnancy in the third Trimester: Case Report

“…Logically, it is higher in case of emergency surgery (32%) and lower after planned intervention (3%) [11]. About pregnancy, acute complications are more common during third trimester, delivery and early puerperium.…”

“…Transabdominal approach is most used; it offers good access to herniated organs and so, it should be used when the patient has signs of intestinal ischemia, like in the present case [10,12]. Laparoscopic and thoracoscopic repairs of the left sided Bochdalek hernia have also been performed successfully [2,11]. As our patient was operated in a surgical emergency a laparoscopic intervention was not advisable.…”

“…But in case of non-repaired DH most authors accept elective caesarean section; hernia repair can be done at the same time but it is not mandatory [8,9]. Recently, other authors have proposed a more conservative action in asymptomatic defects; they argue that vaginal delivery is safe, whenever precautions are taken: planned labor, regional anesthesia and instrumentation to shorten the second stage, and always with the possibility to immediate surgical repair if complications develop [11]. In our case, this option was not possible because of patient´s symptoms.…”

“…Gastric decompression (nasogastric tube) may improve clinical condition and delay surgery until transfer to a tertiary center or until corticosteroids are effective. Antenatal corticosteroids should be dispensed if gestational age is between 24 and 34 weeks and surgery can be postponed [11].…”