Antenatal management and outcomes of pregnancies with congenital diaphragmatic hernia

Örgül, Gökçen; Aydın, Emine; Kayki, Gozdem; Çelik, Hasan Tolga; Soyer, Tutku; Yiğit, Şule; Yurdakök, Murat; Beksaç, Mehmet Sinan

doi:10.3233/npm-190266

Cited by 5 publications

(4 citation statements)

References 36 publications

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“…Tanacan et al similarly classified the location of the stomach in their study of 44 pregnant women with CDH. They found that the stomach was in the abdomen in more than 50% of the surviving neonates, second most commonly in the anterior left thorax (19). Our study found a grade 2 stomach position in 50% of the surviving infants, suggesting an increased survival rate.…”

Section: Table 2 Comparison Of Stomach Position Degrees Among Neonata...supporting

confidence: 53%

Konjenital Diyafragma Hernisi Tanılı Fetüslerde Prognostik Marker Olarak Mide Pozisyonu

Agaoglu

Ağaoğlu

Üstünyurt

et al. 2023

Jinekoloji-Obstetrik Ve Neonatoloji Tıp Dergisi

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Aim: To examine the relationship between stomach position and neonatal survival in congenital diaphragmatic hernia (CDH). Materials and Method: A total of 36 pregnant women with a diagnosis of fetal CDH, aged between 18-45 years and 22-39 weeks of gestation, who applied Ankara City Hospital Perinatology clinic between December 2019 and December 2022, were analyzed retrospectively. Pregnancies were classified into two categories based on neonatal survival. Demographic characteristics, clinical features and contralateral lung size/head circumference (LHR) ratio, stomach position, and other prognostic indicators were evaluated among the survivor (n=8) and non-survivor (n=22) groups. Results: The mean maternal age was 29.30 ± 1.02 (range 17-40), and 36% (13/36) of the patients were primigravid. The median gestational week at diagnosis was 25.10 (13.5-37.6). There was no statistically significant difference between the survivor and non-survivor groups in terms of CDH type, liver position, gestational week at diagnosis, and median LHR. Grade 2 stomach position was found to be statistically significantly higher in the survivor group (p=0.01). Operation rate and 1st-5th minute Apgar scores were higher than in the non-survivor group (p=0.02, p=0.01, and p=0.00, respectively). Conclusion: Stomach position grading in CDH is a practical and applicable method associated with neonatal survival, and grade 2 stomach position may be a marker associated with increased survival in fetuses with CDH regardless of LHR. It may be useful in assessing neonatal prognosis and planning perinatal management, such as maternal transfer to a tertiary center where fetal interventions are available.

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Section: Table 2 Comparison Of Stomach Position Degrees Among Neonata...supporting

confidence: 53%

Konjenital Diyafragma Hernisi Tanılı Fetüslerde Prognostik Marker Olarak Mide Pozisyonu

Agaoglu

Ağaoğlu

Üstünyurt

et al. 2023

Jinekoloji-Obstetrik Ve Neonatoloji Tıp Dergisi

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“…[ 12 ] LHR <1 carries a poor survival, with a value <0.6 carrying 100% mortality. [ 13 ] In our series, of five foetuses with antenatal diagnosis of CDH, two cases with LHR of 0.6 and 0.9 died immediately after birth. Rest of the 3 (60%) with an average LHR >1 underwent surgery and are surviving in good health at 2-year follow-up.…”

Section: Discussionmentioning

confidence: 78%

Antenatally Detected Thoracic Lesions

Ali,

Tank,

Bawa

2023

African Journal of Paediatric Surgery

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Background: Foetal thoracic lesions are uncommon, with the incidence of 1 in 15,000 live births. Antenatal monitoring of these lesions is required to prognosticate the parents about the postnatal outcome of the lesions and about the well-being of the baby. Foetal ultrasound and magnetic resonance imaging (MRI) are the modalities to detect these lesions and follow-up during pregnancy and postnatally. Congenital pulmonary adenomatoid malformations (CPAM), congenital diaphragmatic hernia (CDH) and bronchopulmonary sequestrations (BPS) are the commonly detected foetal thoracic lesions. Parameters such as congenital cystic adenomatoid malformation (CCAM) volume ratio (CVR) and lung-to-head ratio (LHR) determine the prognosis of these lesions. With this background, we planned to study the prognosis and outcome of antenatally detected thoracic lesions. Materials and Methods: This was a prospective study carried out for 2 years (January 2017 to December 2018). Pregnant females with foetuses diagnosed to have thoracic lesions on the second- and third-trimester ultrasound and foetal MRI were enrolled for the study. CVR and LHR were noted. Outcomes were analysed in terms of the need of termination of pregnancy, foetal or neonatal demise and need of surgery or conservative management. Results: Of a total of 521 pregnancies, thoracic lesions were detected in 22 (4.22%) cases. Individually, the incidence of each lesion was: CPAM-10 (45.45%), BPS-5 (22.73%), CDH-5 (22.73%) and congenital higher airway obstruction-2 (9.1%). Chromosomal screening was normal in 100% of cases. Follow-up was done for 2 years. Termination of pregnancy was required in 3 (13.64%) cases, postnatal death occurred in 4 (18.2%) cases, surgery was required in three cases of CDH soon after birth and two cases of extralobar BPS at 2 years of age. 10 (45.45%) cases were managed conservatively, who are doing well at 2-year follow-up. Conclusion: CPAMs, BPSs and CDH are the commonly detected antenatal thoracic lesions. Ultrasonography and MRI help detect and prognosticate the parents about the outcomes of these lesions. CVR and LHR with associated congenital malformations are important prognostic markers for these lesions. There is a need of long-term prospective studies to delineate the natural history of these lesions.

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“…Many studies have pointed out that o/e FLV is a prognostic factor for mortality [ 7 , 16 , 21 , 22 , 23 , 24 ]. Cordier et al reported a link between o/e FLV and mortality: an o/e FLV < 15% was associated with mortality in 88% of cases with upward liver migration.…”

Section: Discussionmentioning

confidence: 99%

Fetal Lung Volume Appears to Predict Respiratory Morbidity in Congenital Diaphragmatic Hernia

Cerbelle

Duc

Lejeune

et al. 2023

JCM

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Congenital diaphragmatic hernia (CDH) is associated with pulmonary hypoplasia and respiratory morbidity. To assess whether respiratory morbidity during the first 2 years of life in infants with left-sided CDH is associated with fetal lung volume (FLV) evaluated by the observed-to-expected FLV ratio (o/e FLV) on antenatal magnetic resonance imaging (MRI). In this retrospective study, o/e FLV measures were collected. Respiratory morbidity in the first 2 years of life was studied according to two endpoints: treatment with inhaled corticosteroids for >3 consecutive months and hospitalization for any acute respiratory disease. The primary outcome was a favorable progression defined by the absence of either endpoint. Forty-seven patients were included. The median o/e FLV was 39% (interquartile range, 33–49). Sixteen (34%) infants were treated with inhaled corticosteroids and 13 (28%) were hospitalized. The most efficient threshold for a favorable outcome was an o/e FLV ≥ 44% with a sensitivity of 57%, specificity of 79%, negative predictive value of 56%, and positive predictive value of 80%. An o/e FLV ≥ 44% was associated with a favorable outcome in 80% of cases. These data suggest that lung volume measurement on fetal MRI may help to identify children at lower respiratory risk and improve information during pregnancy, patient characterization, decisions about treatment strategy and research, and personalized follow-up.

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Antenatal management and outcomes of pregnancies with congenital diaphragmatic hernia

Cited by 5 publications

References 36 publications

Konjenital Diyafragma Hernisi Tanılı Fetüslerde Prognostik Marker Olarak Mide Pozisyonu

Konjenital Diyafragma Hernisi Tanılı Fetüslerde Prognostik Marker Olarak Mide Pozisyonu

Antenatally Detected Thoracic Lesions

Fetal Lung Volume Appears to Predict Respiratory Morbidity in Congenital Diaphragmatic Hernia

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