Congenital diaphragmatic hernia: can prenatal ultrasonography predict outcome?

Am J Obstet Gynecol. 1996 Apr;174(4):1377-81. doi: 10.1016/s0002-9378(96)70688-9.

Abstract

Objective: We wanted to establish whether prenatal ultrasonography predicts postnatal outcome in congenital diaphragmatic hernia.

Study design: We designed a retrospective multicenter cohort study of 135 patients with congenital diaphragmatic hernia (122 left, 10 right, 2 bilateral, 1 anterior). In isolated left congenital diaphragmatic hernia five potential prenatal prognostic factors were studied: diagnosis at < or = 25 weeks' gestation, polyhydramnios, intrathoracic stomach, small abdomen, and major mediastinal shift.

Results: None of the 44 fetuses or infants who had multiple malformations survived. Of the 91 cases of isolated congenital diaphragmatic hernia, there were 82 live births; 76 of these infants had a left congenital diaphragmatic hernia. Of these, 51 (67%) died postnatally. A statistically significant relation was found between mortality and polyhydramnios, intrathoracic stomach, and major mediastinal shift. Mortality increased as a function of the number of these prognostic factors from 20% when none was present to 94% when all three were present.

Conclusion: In the majority of cases of isolated left congenital diaphragmatic hernia the prognostic value of fetal ultrasonography is too low to alter perinatal management.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Congenital Abnormalities
  • Female
  • Fetal Death / complications
  • Gestational Age
  • Hernia, Diaphragmatic / complications
  • Hernia, Diaphragmatic / diagnostic imaging*
  • Hernias, Diaphragmatic, Congenital*
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Pregnancy
  • Prognosis
  • Retrospective Studies
  • Ultrasonography, Prenatal*