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Antenatal diagnosis of congenital diaphragmatic hernia
1Diagnostic Imaging Shared Services, Grace Maternity Hospital, Halifax, NS.
Insights
Congenital diaphragmatic hernia (CDH) survival is improving, even with early antenatal diagnosis. This study shows better outcomes for CDH patients, challenging the notion of uniform fatality before 24 weeks gestational age.
Area of Science:
- Perinatal medicine
- Pediatric surgery
- Medical imaging
Background:
- Congenital diaphragmatic hernia (CDH) historically has a high mortality rate, particularly when diagnosed antenatally.
- Early reports indicated near-universal mortality for CDH diagnosed before 24 weeks gestational age.
Purpose of the Study:
- To determine the in-hospital mortality rate for antenatally diagnosed congenital diaphragmatic hernia (CDH).
- To evaluate the impact of gestational age at diagnosis on CDH outcomes.
- To assess the accuracy of antenatal ultrasonography (US) in diagnosing CDH.
Main Methods:
- Retrospective review of 11 cases of CDH diagnosed between 1987 and 1990 at a tertiary-care hospital.
- All cases had antenatal ultrasonography (US) performed at the institution.
- Analysis of survival rates based on antenatal diagnosis and gestational age.
Main Results:
- Overall survival was 7 out of 11 patients.
- Four of the seven antenatally diagnosed cases survived.
- Two of three patients diagnosed before 21 weeks gestational age survived.
- False-negative diagnoses occurred in four cases, all right-sided hernias, with three of these patients surviving.
Conclusions:
- The prognosis for antenatally diagnosed CDH appears to be improving.
- CDH is not uniformly fatal, even when diagnosed before 24 weeks gestational age.
- Antenatal diagnosis and gestational age are critical factors influencing CDH outcomes.
Abstract:
The mortality rate in cases of antenatally diagnosed congenital diaphragmatic hernia (CDH) remains high: 80% to 100% mortality was reported in early series and 73% in a more recent series. In addition, the early reports described 100% mortality for cases diagnosed before 24 weeks gestational age. To determine the mortality rate in patients at their institution (a specialized tertiary-care hospital), the authors reviewed 11 cases of CDH diagnosed from 1987 to 1990, for all of which antenatal ultrasonography (US) had been performed at the hospital. Overall, 7 of the 11 patients survived. In seven of the cases the condition had been diagnosed antenatally. Of these patients, four survived, including two of the three in whom the diagnosis had been made before 21 weeks gestational age. All four false-negative cases involved a right-side hernia, and in three of these the prenatal US examinations had been performed before 16 weeks gestational age. Three of these four patients survived. This study suggests that the prognosis in antenatally diagnosed CDH is improving and confirms that this condition is not uniformly fatal in cases diagnosed before 24 weeks gestational age.
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