Maternal diaphragmatic hernia in pregnancy: A systematic review with a treatment algorithm

Area of Science:

• Obstetrics and Gynecology
• Surgical Gastroenterology
• Medical Diagnostics

Background:

• Diaphragmatic hernia (DH) is exceptionally rare during pregnancy, lacking established diagnostic and treatment guidelines.
• The rarity of DH in pregnancy necessitates a review of existing literature to inform clinical practice.

Purpose of the Study:

• To consolidate and define optimal diagnostic methods for DH in pregnant individuals.
• To outline the most appropriate therapeutic strategies for DH during pregnancy.

Main Methods:

• Comprehensive literature search across multiple languages using PubMed, PubMed Central, and Google Scholar.
• Adherence to the PRISMA protocol for systematic review, including specific search terms related to maternal diaphragmatic hernia and pregnancy.
• Extraction of demographic, imaging, surgical, and obstetric data from 158 collected cases.

Main Results:

• Congenital hernias constituted an increasing proportion of DH cases over time.
• Diagnostic accuracy for DH in pregnancy was 50%; DH type did not impact maternal or neonatal outcomes.
• A short presentation (less than 3 days) significantly increased the risk of strangulation in pregnant patients.

Conclusions:

• Diaphragmatic hernia symptoms can mimic common chest conditions, leading to diagnostic delays and increased mortality.
• DH should be considered in pregnant women presenting with abdominal pain, dyspnea, chest pain, and collapse.
• Early diagnosis and intervention, alongside a proposed management algorithm, are vital for favorable maternal and fetal outcomes in DH pregnancies.