title: Outcomes of multigestational pregnancies affected by congenital diaphragmatic hernia.
abstract: OBJECTIVE
  The prognosis for multiple vs singleton pregnancies affected by congenital diaphragmatic hernia (CDH) is not known. To improve the counseling of families with multiple gestation pregnancies complicated by CDH, we examined outcomes of a consecutive series of CDH cases occurring in multiple gestation pregnancy referrals.
  
  
  METHODS
  Clinical characteristics and morbidity and mortality data were gathered for a consecutive series of infants with CDH from 16 multiple gestation pregnancies. Outcomes were compared to a cohort of 91 patients with CDH from singleton pregnancies. Multivariate regression was also used in an attempt to determine whether multiple gestation pregnancy was independently predictive of subsequent long-term adverse outcomes.
  
  
  RESULTS
  Four pregnancies were lost to follow-up, and 1 underwent selective reduction. Overall mortality for live-born multiple gestation fetuses affected by CDH was 30% and was 8% for unaffected siblings. No pregnancy was concordant. Clinical features were not different between the case series and control infants, except median gestational age at delivery, which was significantly lower for the multigestational infants (34 [range, 32-36] vs 38 [range, 28-41] weeks) (P = .02). Long-term morbidity was comparable between cases and controls.
  
  
  CONCLUSIONS
  In terms of mortality, outcomes of multigestational pregnancies affected by CDH are no worse than for CDH pregnancies in general. Long-term risk may depend more on CDH severity rather than the presence of multiple fetuses.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, University of California, San Francisco, CA 94143, USA. tim.jancelewicz@ucsfmedctr.org
authors.forename: Tim
authors.initials: T
authors.lastname: Jancelewicz
authors.forename: Lan T
authors.initials: LT
authors.lastname: Vu
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Keller
authors.forename: Eric B
authors.initials: EB
authors.lastname: Jelin
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Bratton
authors.forename: Tiffany C
authors.initials: TC
authors.lastname: Townsend
authors.forename: Kerilyn K
authors.initials: KK
authors.lastname: Nobuhara
mesh_terms: D002648:Child; D005260:Female; D006548:Hernia, Diaphragmatic / Q000453:epidemiology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011379:Prognosis