Experiences in the Perinatal Management of Congenital Diaphragmatic Hernia during the Last 15 Years in a Tertiary Referral Institute

Abstract

Objective: Review of cases of perinatally diagnosed congenital diaphragmatic hernias with special regard to time of diagnosis, organs herniated into the thorax, associated malformations, and outcomes. Methods: We analyzed the data of 106 cases between July 1, 1990, and June 30, 2005. The observation period was analyzed in two parts. Results: Prenatal ultrasound was performed in 89.6% (95/106) of the cases. 51.7% (46/89) of the pre- and postnatally verified congenital diaphragmatic hernia cases were diagnosed before the 24th week of gestation. 11% (11/100) of the hernias were identified postnatally. 71% (71/100) of the cases were associated with other malformations. The hernia was on the left side in 86% (86/100) and bilateral in 5% (5/100) of the cases. Between 1990 and 1997, the proportion of right-sided hernias was 4.3% (2/46), while during the second period it was 13% (7/54). 27.5% (14/51) of the newborns survived the perinatal period. The survival rate of the newborns delivered by caesarean section was three times higher than that of infants delivered vaginally. In the latter group, the rate of premature deliveries was considerably higher. The pregnancy was terminated in 45% (40/89) of the cases. 15% (6/40) of the terminated cases were isolated. Intrauterine or intrapartum deaths occurred in 5.6% (5/89) of the prenatally diagnosed cases. Simultaneous thoracic herniation of liver, spleen, or stomach decreased the survival rate. In these cases, the discharge rate was between 6 and 22%. Conclusions: According to the analysis of 15-year data, the herniated organs, multiple malformations, as well as the mode of delivery influence the survival in a large number of cases. Early diagnosis predicts a large hernia, a higher malformation rate, and a less favourable prognosis.

Evaluation of Normal Fetal Branch Pulmonary Artery Diameters Measured by Ultrasonography: A Comparison with Congenital Diaphragmatic Hernia

“…This allowed the calculation of the LPA to MPA (LPA/ MPA) ratio and RPA to MPA (RPA/MPA) ratio, which were independent of gestation. As a preliminary study, these branch PA diameters in the normal fetuses were compared with those in cases of congenital diaphragmatic hernia (CDH), which has a poor prognosis caused by pulmonary hypoplasia, even if found prenatally [10] .…”

Risk factors and outcomes for congenital diaphragmatic hernia in neonatal intensive care unit patients

“…The survive rate of CDH in NICU appears, therefore, to be similar in comparison to recent studies in high-risk CDH patients, (6,13) but to be lower in comparison to some other studies in isolated CDH patients. (14,15) In our study, we compared CDH patients who survived with non-survivors, and found that survivors were associated with an excess NICU length of stay.…”

The Prognostic Factors of Congenital Diaphragmatic Hernia Patients and The Evaluation of The Effects of Lung Development With Ventilation-Perfusion Scintigraphy

“…Çalışmamızda, cinsiyetle yaşam oranı arasında anlamlı ilişki saptanmamıştır. 106 olguluk bir çalışmada, C/S ile doğan olgularda sağkalım oranının vajinal yolla doğanlara göre 3 kat daha fazla olduğu saptanmıştır (22) . Bir çalışmada ise, doğum şeklinin sağkalımı etkilemediği saptanmamış-tır (23) .…”