Prognosis in fetal diaphragmatic hernia

Area of Science:

• Perinatal medicine
• Fetal surgery
• Pediatric surgery

Background:

• Congenital diaphragmatic hernia (CDH) presents a significant challenge in perinatal care.
• High mortality rates are associated with prenatally detected CDH.
• Early presentation and polyhydramnios are suspected adverse prognostic factors.

Purpose of the Study:

• To retrospectively analyze outcomes of prenatally diagnosed congenital diaphragmatic hernia.
• To evaluate the impact of gestational age at diagnosis on mortality.
• To identify reliable prognostic indicators for fetal CDH.

Main Methods:

• Retrospective review of 55 cases of prenatally diagnosed CDH.
• Analysis of mortality rates based on gestational age at diagnosis.
• Assessment of factors including polyhydramnios, cardiac development, chromosomal anomalies, and heart disease.

Main Results:

• Overall mortality for prenatally detected CDH was 73%.
• Mortality was 74% for diagnosis before 25 weeks' gestation (excluding terminations) versus 60% after 25 weeks.
• Underdevelopment of left-sided cardiac structures was a significant prognostic factor; polyhydramnios was not confirmed as predictive.

Conclusions:

• While diagnosis before 25 weeks' gestation is linked to higher mortality, it is not universally fatal.
• Exclusion of congenital heart disease, chromosomal anomalies, and severe left heart underdevelopment improves survival odds.
• Prognostic factors must be considered in the management planning for fetal CDH.