Prenatal assessment of congenital diaphragmatic hernia at north american fetal therapy network centers: A continued plea for standardization

Prenat Diagn. 2021 Jan;41(2):200-206. doi: 10.1002/pd.5859. Epub 2020 Nov 12.


Introduction: Prenatal work-up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling, and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work-up, including prenatal ultrasound and magnetic resonance imaging (MRI) use, and to identify areas for standardization of such evaluation between fetal centers.

Methods: A survey regarding prenatal CDH work-up was sent to each member center of the North American Fetal Therapy Network (NAFTNet) (n = 36).

Results: All responded. Sonographic measurement of lung-to-head ratio (LHR) was determined by all, 89% (32/36) of which routinely calculate observed-to-expected LHR. The method for measuring LHR varied: 58% (21/36) used a "trace" method, 25% (9/36) used "longest axis," and 17% (6/36) used an "antero-posterior" method. Fetal MRI was routinely used in 78% (28/36) of centers, but there was significant variability in fetal lung volume measurement. Whereas all generated a total fetal lung volume, the planes, methodology and references values varied significantly. All evaluated liver position, 71% (20/28) evaluated stomach position and 54% (15/28) quantified the degree of liver herniation. More consistency in workup was seen between centers offering fetal intervention.

Conclusion: Prenatal CDH work-up and management differs considerably among North American fetal diagnostic centers, highlighting a need for its standardization.

MeSH terms

  • Counseling
  • Female
  • Hernias, Diaphragmatic, Congenital / diagnosis*
  • Hernias, Diaphragmatic, Congenital / diagnostic imaging
  • Humans
  • Liver / diagnostic imaging*
  • Lung / diagnostic imaging*
  • Lung / embryology
  • Magnetic Resonance Imaging / methods*
  • North America
  • Organ Size
  • Practice Patterns, Physicians'*
  • Pregnancy
  • Prenatal Care / methods*
  • Reference Standards
  • Surveys and Questionnaires
  • Ultrasonography, Prenatal / methods*