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[Current options of prenatal diagnosis in congential diaphragmatic hernia]
Z Stranák1, I Kucerová, I Urbánková
1Ustav patologie VFN a 1. LF UK. z.stranak@seznam.cz
Insights
Prenatal diagnosis of congenital diaphragmatic hernia (CDH) primarily uses 2D ultrasound, assessing lung-to-head ratio and associated anomalies. Advanced imaging and specialized centers improve diagnosis and therapy for CDH.
Area of Science:
- Medical Imaging
- Prenatal Medicine
- Pediatric Surgery
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect requiring accurate prenatal diagnosis.
- Early identification of CDH is crucial for planning management and improving outcomes.
Purpose of the Study:
- To review current prenatal diagnostic methods for congenital diaphragmatic hernia (CDH).
- To outline the key imaging techniques and prognostic indicators for CDH.
Main Methods:
- Systematic review of published literature.
- Analysis of diagnostic capabilities of 2D and 3D ultrasonography.
- Evaluation of magnetic resonance imaging (MRI) and Doppler parameters.
Main Results:
- 2D ultrasonography is the primary diagnostic tool, measuring lung-to-head ratio (LHR) and assessing liver position.
- 3D ultrasound and MRI aid in fetal lung volume measurement and anomaly confirmation.
- Hyperoxygenation tests and Doppler studies evaluate pulmonary artery reactivity.
Conclusions:
- Prenatal diagnosis of CDH relies on a combination of imaging techniques and prognostic factor assessment.
- Invasive prenatal diagnostics are not indicated for isolated CDH.
- Centralization of CDH cases in specialized centers is vital for successful prenatal diagnosis and therapy.
Objective:
The aim of this article is to review the current options of prenatal diagnosis in congential diaphragmatic hernia (CDH).
Subject:
Systematic review.
Setting:
Institute for the Care of Mother and Child, 3rd Medical Faculty, Prague.
Subject And Method:
Review of recent published data.
Conclusion:
The basic method for prenatal diagnosis of congenital diaphragmatic hernia is 2D ultrasonography: measurement of lung-to-head ratio (LHR), observed to expected lung to head ratio (observed to expected LHR - O/E LHR), localization of diaphragmatic defect, assessment of liver position and presence of associated anomalies (negative prognostic factors). Prenatal diagnosis can be supplied with 3D ultrasonography and magnetic resonace (imaging methods for valid measurement of fetal lung volume and/or presence of associated congenital defects confirmation). The reactivity of intrapulmonary arteries are evaluated by hyperoxygenation test and measurement of arterial Doppler parameters. Isolated diaphragmatic hernia is not an indication for invasive prenatal diagnostic methods. Important part of succesful prenatal diagnosis and therapy of CDH is concentration of cases in specialized centre.
