Spontaneous prematurity in fetuses with congenital diaphragmatic hernia: a retrospective cohort study about prenatal predictive factors

Abstract

BackgroundTo evaluate possible predictive factors of spontaneous prematurity in fetuses with congenital diaphragmatic hernia (CDH).MethodsA retrospective cohort study was performed. Inclusion criteria were presence of CDH; absence of fetoscopy; absence of karyotype abnormality; maximum of one major malformation associated with diaphragmatic hernia; ultrasound monitoring at the Obstetrics Clinic of Clinicas Hospital at the University of São Paulo School of Medicine, from January 2001 to October 2014. The data were obtained through the electronic records and ultrasound system of our fetal medicine service. The following variables were analyzed: maternal age, primiparity, associated maternal diseases, smoking, previous spontaneous preterm birth, fetal malformation associated with hernia, polyhydramnios, fetal growth restriction, presence of intrathoracic liver, invasive procedures performed, side of hernia and observed-to- expected lung to head ratio (o/e LHR). On individual analysis, variables were assessed using the Chi-square test and the Mann-Whitney test. A multiple logistic regression model was applied to select variables independently influencing the prediction of preterm delivery. A ROC curve was constructed with the significant variable, identifying the values with best sensitivity and specificity to be suggested for use in clinical practice.ResultsEighty fetuses were evaluated, of which, 21 (26.25%) were premature. O/e LHR was the only factor associated with prematurity (p = 0.020). The ROC curve showed 93% sensitivity with 48.4% specificity for the cutoff of 40%.ConclusionO/e LHR was the only predictor of prematurity in this sample.

Trends, correlates, and survival of infants with congenital diaphragmatic hernia and its subtypes

“…A possible reason for the increased risk for prematurity is that fetuses diagnosed with congenital diaphragmatic hernia may be delivered earlier by elective cesarean delivery. A study in Brazil found decreased observed-to-expected lung to head ratio, a variable that we could not measure in our study, a predictor for increased spontaneous prematurity (Barbosa et al, 2018). Since we found survival rates to be lower in LBW/VLBW infants, irrespective of gestational age, it may suggest a greater role for birth weight rather than gestational age in the prognosis of infants with congenital diaphragmatic hernia.…”

What should we tell parents? Congenital diaphragmatic hernia

“…When expectant management is chosen, maternal follow up is comparable to those of uncomplicated pregnancies. Given the increased occurrence of polyhydramnios (more than 30% by the third trimester 39 ), ultrasound scans are usually performed on a monthly basis. In cases with polyhydramnios and shortening of the cervix ultrasound-guided drainage of the excessive amniotic fluid may be RUSSO ET AL.…”

Hérnia diafragmática Congênita: aspectos clínico-hospitalares em um hospital de referência materno-infantil na região Amazônica

“…A total of 25,602 records were analyzed, of which 14 corresponded to CDH. The gender involvement was 71.43% male (10 cases) and 28.57% female (4), with 21.34% of Bochdalek-type CDH located on the right (3) and 78.57% on the left (11). All newborns in this study underwent invasive mechanical ventilation (IMV) 9.21 ± 5.55 days.…”

“…This disorder has postnatal consequences, such as pulmonary hypoplasia and pulmonary hypertension, in addition to abnormal pulmonary vasculature morphology. CDH culminates in indicators of high morbidity and mortality around 50-60%, and individuals with this condition require intensive specialized care 3,4 .…”