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Diaphragmatic hernias complicating pregnancy.
Timothyw Eglinton1, Grant N Coulter, Philipf Bagshaw
1Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand. t.eglinton@xtra.co.nz
ANZ Journal of Surgery
|July 4, 2006
Summary
Diaphragmatic hernias during pregnancy are rare but serious, often requiring emergency surgery. Early surgical repair in the second trimester is recommended for asymptomatic cases to prevent life-threatening complications.
Area of Science:
- Obstetrics and Gynecology
- Surgical Gastroenterology
- Maternal-Fetal Medicine
Background:
- Non-hiatal diaphragmatic hernias in pregnancy are uncommon but can lead to severe maternal and fetal complications.
- These hernias can manifest as emergencies or be incidentally discovered, posing management challenges.
Observation:
- Three emergency cases in the third trimester presented with thoracic compression, necessitating laparotomy and, in one instance, thoracotomy.
- Two patients underwent Cesarean sections during emergency surgery; one had a delayed delivery.
- A review identified 36 previously reported cases, highlighting the rarity of diaphragmatic hernias in pregnancy.
Findings:
- Strangulated hernias require immediate surgical intervention regardless of gestational age.
- Management of asymptomatic hernias is debated, with options including conservative approaches and elective surgery.
- Outcomes included one fetal demise, no maternal deaths, one maternal pleural infection, and one infant requiring postnatal hernia repair.
Implications:
- Surgical repair in the second trimester should be considered for asymptomatic diaphragmatic hernias identified during pregnancy.
- Vaginal delivery in the presence of a diaphragmatic hernia requires meticulous monitoring.
- Prompt surgical management is crucial for diaphragmatic hernias complicating pregnancy to improve maternal and fetal outcomes.