Prenatal diagnosis and management of congenital diaphragmatic hernia

Prenatal treatment of severe congenital diaphragmatic hernia: there is still medical equipoise

“…Therefore, simultaneous efforts have been made to define accurately the natural history of CDH. The use of fetal imaging methods to measure lung size and liver herniation has been explored, along with the correlation of these findings with neonatal mortality and early morbidity (reviewed by Basurto et al 17 …”

“…Therefore, simultaneous efforts have been made to define accurately the natural history of CDH. The use of fetal imaging methods to measure lung size and liver herniation has been explored, along with the correlation of these findings with neonatal mortality and early morbidity (reviewed by Basurto et al 17 ). This has led to the identification of candidates for fetal surgery by a decision tree based on the observed/expected (o/e) lung-to-head ratio (LHR) and liver position, and classification of fetuses as having severe, moderate or mild hypoplasia, correlating with survival rates of 22%, 50% and > 70%, respectively, in left-sided isolated CDH 18 (Figure 1).…”

“…CDH, congenital diaphragmatic hernia; o/e LHR, observed/expected lung-to-head ratio; TO, tracheal occlusion. Adapted with permission from Basurto et al 17 .…”

Prenatal regenerative fetoscopic interventions for congenital anomalies

“…While ongoing efforts to improve detection rates are needed, additional goals of prenatal evaluation have focused on prognostication markers for counseling prospective parents and identifying high risk fetuses that could benefit from early in utero intervention 4142. Different prognostic indicators have been proposed, but the most commonly used include the observed-to-expected lung-to-head ratio (o/e LHR) and observed-to-expected total lung volume (o/e TLV) as well as liver herniation (table 1).…”

The use of MRI in fetal conditions amenable for antenatal management

“…Decisions on intrauterine treatment of congenital diaphagmatic hernia (CDH) are based on certain anatomical details, predicting the probability of postnatal survival . US features are liver position and cross‐section of the contralateral lung at the four‐chamber view .…”