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The role of prenatal diagnosis in congenital diaphragmatic hernia
Y Nirasawa1, Y Ito, K Satsumabayashi
1Department of Pediatric Surgery, Kyorin University, School of Medicine, Tokyo, Japan.
Prenatal diagnosis of surgically correctable fetal anomalies is increasing with the improvement of ultrasonographic techniques. In spite of theoretical advantages, the mortality rate in cases of CDH presenting in the early hours of life has remained high. We have experience of two consecutive cases of CDH, diagnosed prenatally. With maternal transport, planned delivery by Cesarean section, immediate resuscitation of the babies after birth, and prompt surgical intervention by pediatric surgeons, the babies were successfully managed even though they had severe hypoplasia of the left lung. Other reported cases of CDH, have died in the neonatal period mainly from associated lethal anomalies and contralateral lung hypoplasia and in spite of prenatal diagnosis and early surgical intervention. Most of these cases belong to group 3 in Ein's classification. Cases belonging to group 3 are virtually impossible to save with current medical techniques. The effects of prenatal diagnosis on the survival rate in CDH have been discouraging in those series which include these types of cases. The advantage of prenatal diagnosis and early surgical intervention are obvious in groups 1 and 2. Our cases show the importance of cooperation between obstetricians, neonatologists and pediatric surgeons in the prenatal and postnatal management of babies with CDH.
Prenatal diagnosis of surgically correctable fetal anomalies is increasing with the improvement of ultrasonographic techniques. In spite of theoretical advantages, the mortality rate in cases of CDH presenting in the early hours of life has remained high. We have experience of two consecutive cases of CDH, diagnosed prenatally. With maternal transport, planned delivery by Cesarean section, immediate resuscitation of the babies after birth, and prompt surgical intervention by pediatric surgeons, the babies were successfully managed even though they had severe hypoplasia of the left lung. Other reported cases of CDH, have died in the neonatal period mainly from associated lethal anomalies and contralateral lung hypoplasia and in spite of prenatal diagnosis and early surgical intervention. Most of these cases belong to group 3 in Ein's classification. Cases belonging to group 3 are virtually impossible to save with current medical techniques. The effects of prenatal diagnosis on the survival rate in CDH have been discouraging in those series which include these types of cases. The advantage of prenatal diagnosis and early surgical intervention are obvious in groups 1 and 2. Our cases show the importance of cooperation between obstetricians, neonatologists and pediatric surgeons in the prenatal and postnatal management of babies with CDH.