title: Outcome of fetuses with congenital diaphragmatic hernia and associated intrafetal fluid effusions managed in the era of fetal surgery.
abstract: OBJECTIVE
  Fetuses with congenital diaphragmatic hernia (CDH) and for whom additional ultrasound findings are abnormal typically are considered to have a dismal prognosis. Our aim was to assess the outcome of fetuses with CDH and associated intrafetal fluid effusions.
  
  
  METHODS
  This was a retrospective bicentric cohort study on the perinatal management of fetuses with CDH and intrafetal fluid effusions.
  
  
  RESULTS
  The incidence of effusions was 5.2% (n = 14) in 269 consecutive cases of left-sided CDH and 29.2% (n = 14) in 48 cases of right-sided CDH. Hydrothorax (n = 19 (68%)) and ascites (n = 16 (57%)) were the most common effusions. A combination of both was present in 11 (39%) fetuses. Of 20 ongoing pregnancies with CDH and fluid effusions, without other anomalies, five with moderate or mild pulmonary hypoplasia were managed without fetoscopic endoluminal tracheal occlusion (FETO). The 15 other cases underwent FETO because of severe pulmonary hypoplasia. Neonatal survival rate was similar in both groups (n = 2/5 and n = 6/15, respectively (P = 1.0)). Survival among those who underwent FETO was similar to previously published results concerning isolated cases undergoing FETO.
  
  
  CONCLUSIONS
  Our observations do not support the view that intrafetal effusions are an adverse prognostic factor in fetuses with CDH. In CDH fetuses with effusions and severe pulmonary hypoplasia treated with FETO, neonatal survival is similar to that in isolated cases undergoing the intervention. Whether pleural effusions should be addressed by thoracic drainage procedures remains unproven.
authors: Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.
authors: T
authors: T
authors: Van Mieghem
authors: R
authors: R
authors: Cruz-Martinez
authors: K
authors: K
authors: Allegaert
authors: P
authors: P
authors: Dekoninck
authors: M
authors: M
authors: Castanon
authors: I
authors: I
authors: Sandaite
authors: F
authors: F
authors: Claus
authors: R
authors: R
authors: Devlieger
authors: E
authors: E
authors: Gratacos
authors: J
authors: J
authors: Deprest
mesh_terms: D021721:Balloon Occlusion / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005332:Fetoscopy / Q000379:methods; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014132:Trachea / Q000000981:diagnostic imaging*; D016216:Ultrasonography, Prenatal