Experiences in the perinatal management of congenital diaphragmatic hernia during the last 15 years in a tertiary referral institute.
OBJECTIVE
Review of cases of perinatally diagnosed congenital diaphragmatic hernias with special regard to time of diagnosis, organs herniated into the thorax, associated malformations, and outcomes.


METHODS
We analyzed the data of 106 cases between July 1, 1990, and June 30, 2005. The observation period was analyzed in two parts.


RESULTS
Prenatal ultrasound was performed in 89.6% (95/106) of the cases. 51.7% (46/89) of the pre- and postnatally verified congenital diaphragmatic hernia cases were diagnosed before the 24th week of gestation. 11% (11/100) of the hernias were identified postnatally. 71% (71/100) of the cases were associated with other malformations. The hernia was on the left side in 86% (86/100) and bilateral in 5% (5/100) of the cases. Between 1990 and 1997, the proportion of right-sided hernias was 4.3% (2/46), while during the second period it was 13% (7/54). 27.5% (14/51) of the newborns survived the perinatal period. The survival rate of the newborns delivered by caesarean section was three times higher than that of infants delivered vaginally. In the latter group, the rate of premature deliveries was considerably higher. The pregnancy was terminated in 45% (40/89) of the cases. 15% (6/40) of the terminated cases were isolated. Intrauterine or intrapartum deaths occurred in 5.6% (5/89) of the prenatally diagnosed cases. Simultaneous thoracic herniation of liver, spleen, or stomach decreased the survival rate. In these cases, the discharge rate was between 6 and 22%.


CONCLUSIONS
According to the analysis of 15-year data, the herniated organs, multiple malformations, as well as the mode of delivery influence the survival in a large number of cases. Early diagnosis predicts a large hernia, a higher malformation rate, and a less favourable prognosis.
Harmath
Agnes
A
1st Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, Hungary. harmag@noil.sote.hu
Hajdú
Júlia
J
Hauzman
Erik
E
Pete
Barbara
B
Róna
Zsófia
Z
Papp
Zoltán
Z
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000000981:diagnostic imaging; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006814:Hungary; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal