Prognosis in Congenital Diaphragmatic Hernia Diagnosed During Fetal Life

Abstract

Congenital diaphragmatic hernia (CDH) is a malformation that continues to cause significant morbidity and mortality and can be difficult to clinically manage. Determination of prognosis can greatly add to the decision-making process in prenatally recognized CDH, predominantly by the recognition of specific ultrasound findings. Ultrasound findings that are important include hernia type, laterality, lung size, position of the fetal liver and stomach, and the presence or absence of other anomalies. In general, prognosis is best in cases where CDH is an isolated anomaly, the liver and stomach remain within the abdominal cavity, and the lung size corresponds to a lung area to head circumference ratio of ≥1. Position of the stomach also corresponds with prognosis, is easier to reliably determine with ultrasound, and can indirectly predict the position of the liver. The following is a review of the literature and experience in the care of fetuses with CDH at the University of California, San Francisco, a large tertiary referral center, in using these ultrasound findings to predict prognosis.