title: Prognostic value of a hernia sac in congenital diaphragmatic hernia.
abstract: OBJECTIVE
  To investigate the prognostic value of a hernia sac in isolated congenital diaphragmatic hernia (CDH).
  
  
  METHODS
  Our database was searched to identify all consecutive cases of CDH referred to our fetal medicine unit between January 2004 and August 2011. Presence or absence of a hernia sac was assessed in liveborn cases using surgery or postnatal autopsy reports. We studied the correlation between the presence of a hernia sac and prenatal findings and perinatal morbidity and mortality.
  
  
  RESULTS
  Over the study period, there were 70 cases with isolated CDH born alive in which either a surgery or autopsy report was available. Neonatal death, either preoperative or postoperative, occurred in 1/18 (5.6%) infants with a hernia sac and in 17/52 (32.7%) cases without a hernia sac (P = 0.03). Patients with a hernia sac had a significantly higher observed to expected pulmonary volume on prenatal magnetic resonance imaging (51.9 vs 39.3%, P = 0.01). Neonatal morbidity in surviving infants was lower in the group with a hernia sac, although not significantly.
  
  
  CONCLUSIONS
  The presence of a hernia sac is associated with a higher pulmonary volume and a better overall prognosis for CDH.
authors.affiliation: Department of Obstetrics and Maternal-Fetal Medicine, GHU Necker Enfants-Malades, AP-HP and Université Paris Descartes, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Spaggiari
authors.forename: J
authors.initials: J
authors.lastname: Stirnemann
authors.forename: J-P
authors.initials: JP
authors.lastname: Bernard
authors.forename: L
authors.initials: L
authors.lastname: De Saint Blanquat
authors.forename: S
authors.initials: S
authors.lastname: Beaudoin
authors.forename: Y
authors.initials: Y
authors.lastname: Ville
mesh_terms: D005260:Female; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000401:mortality; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate