title: Fetal liver position and perinatal outcome for congenital diaphragmatic hernia.
abstract: Despite advances in postnatal care, patients born with a congenital diaphragmatic hernia (CDH) suffer substantial morbidity and mortality. The present study was undertaken to determine the prognostic influence of prenatally-diagnosed liver herniation in the hemithorax in fetuses with CDH. The medical records of 48 patients evaluated for a prenatally-diagnosed left CDH were retrospectively reviewed. Patients were analysed according to the position of the liver by prenatal ultrasound; 32 fetuses had a major portion of the liver herniated into the left hemithorax ('liver up') and 16 had an intra-abdominal liver ('liver down'). Liver position was determined using colour-flow Doppler ultrasonography. There were two fetal deaths in the liver-up group and one in the liver-down group. The liver-up group more frequently required extracorporeal membrane oxygenation (ECMO) support (53 per cent) compared with the liver-down group (19 per cent). Postnatal survival was significantly less in the liver-up group (43 per cent) vs. the liver-down group (93 per cent). Fetuses with congenital diaphragmatic hernia and liver herniated into the hemithorax have a much worse prognosis than similarly afflicted fetuses without liver herniation. Prenatal ultrasonographic diagnosis of congenital diaphragmatic hernia allows for preparation for a critically ill newborn and aids in prenatal family counselling.
authors.affiliation: Department of Surgery, University of California, San Francisco 94143-0570, USA. craig@itsa.ucsf.edu
authors.forename: C T
authors.initials: CT
authors.lastname: Albanese
authors.forename: J
authors.initials: J
authors.lastname: Lopoo
authors.forename: R B
authors.initials: RB
authors.lastname: Goldstein
authors.forename: R A
authors.initials: RA
authors.lastname: Filly
authors.forename: V A
authors.initials: VA
authors.lastname: Feldstein
authors.forename: P W
authors.initials: PW
authors.lastname: Calen
authors.forename: R W
authors.initials: RW
authors.lastname: Jennings
authors.forename: J A
authors.initials: JA
authors.lastname: Farrell
authors.forename: M R
authors.initials: MR
authors.lastname: Harrison
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005313:Fetal Death; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000473:pathology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000196:embryology* / Q000473:pathology*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal