Prenatal diagnoses and outcomes of congenital diaphragmatic hernia.
OBJECTIVE
To describe the prenatal diagnoses and clinical outcomes of congenital diaphragmatic hernia (CDH).


METHODS
A retrospective case series was developed by reviewing 16,983 ultrasounds performed between March 2003 and January 2006 for the prenatal diagnosis of CDH. Medical records of each mother/infant pair were reviewed for demographic information, ultrasound findings, obstetric management, and outcomes.


RESULTS
Nineteen fetuses were diagnosed with CDH. Only one was lost to follow-up. Median gestational age at diagnosis was 28.4W (range 17.6-36.6). Fifteen cases (79%) were left sided, 3 (16%) were right-sided, and 1 (5%) was bilateral. Seven fetuses (39%) had additional abnormalities, the most common being a single umbilical artery. Ten patients (52.6%) underwent amniocentesis for karyotype; none were aneuploid. Three patients developed hydramnios. All 18 infants were liveborn. Seven infants (39%) died shortly after birth, 6 (33%) underwent surgery with subsequent discharge, and 5 (28%) were transferred to another center. Three of these died after transfer.


CONCLUSIONS
Prenatal diagnosis of CDH portends a poor prognosis. Thirty-nine percent of infants with this diagnosis (7/18) did not survive to undergo surgery or transfer to another facility and overall mortality was 56% (10/18). Targeted ultrasonography, extensive counseling of parents, and delivery at a tertiary care center is recommended.
Laye
M Ryan
MR
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216, USA. mlaye@ob-gyn.umsmed.edu
Rehberg
Jonathan F
JF
Kosek
Mary Ann
MA
Bufkin
Laura K
LK
Bofill
James A
JA
D000293:Adolescent; D000328:Adult; D005260:Female; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000175:diagnosis* / Q000453:epidemiology; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal