Accuracy of sonography in predicting the outcome of fetal congenital diaphragmatic hernia.

Y Y Hsieh, F C Chang, H D Tsai, T Y Hsu, T C Yang
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Abstract

Background: The outcome of congenital diaphragmatic hernia (CDH) remains poor despite recent advances in neonatal care. This study was designed to evaluate the role of sonography in predicting the outcome of CDH.

Methods: Pregnancies with CDH were studied. Fetal survival, morbidity, combined anomalies and mortality were recorded. Seven parameters were recorded, including the presence of hydramnios, side of herniation, cardiac deviation, stomach presence, gestational age at the time of finding the CDH and time of postpartum herniorrhaphy. The predictive values of these parameters for fetal outcome were analyzed.

Results: A total of 31 pregnancies were studied. There were 11 cases (35.5%) of termination, seven cases (22.6%) of perinatal death, four cases (12.9%) of late death and nine cases of survival (29%). The survivor group included four cases (44.4%) of complete recovery and five cases (55.6%) with persistent morbidity. There were 15 cases of simple CDH including eight cases of cardiac anomalies (ventricular-septal defect, atrial-septal defect, patent ductus arteriosus and ventricular dilatation). There were eight cases with severe anomalies (3 with trisomy 18, 2 with Cantrell's pentalogy, 1 with trisomy 13, 1 with cystic hygroma and one with Tetralogy Fallot). Among the seven parameters studied, gestational age at the time of finding the CDH and hydramnios were related to fetal survival.

Conclusions: Sonography assists in predicting the postnatal outcome of CDH. Diagnosis of CDH at less than 25 weeks' gestation and the existence of hydramnios are associated with higher mortality. Postnatal therapy and prenatal surgical intervention are necessary to salvage fetuses in the presence of these two situations. The survival rate of infants with CDH was 45%. Of these, 55.6% had persistent morbidity. Prenatal counseling should reflect this.

超声预测胎儿先天性膈疝预后的准确性。
背景:尽管最近新生儿护理取得进展,先天性膈疝(CDH)的预后仍然很差。本研究旨在评估超声在预测CDH预后中的作用。方法:对妊娠合并CDH进行研究。记录胎儿存活率、发病率、合并畸形和死亡率。记录羊水是否存在、侧边疝、心偏曲、胃是否存在、发现CDH时的胎龄、产后疝修补时间等7项参数。分析了这些参数对胎儿结局的预测价值。结果:共对31例妊娠进行了研究。终止妊娠11例(35.5%),围产期死亡7例(22.6%),晚期死亡4例(12.9%),存活9例(29%)。存活组中4例(44.4%)完全康复,5例(55.6%)持续发病。单纯性CDH 15例,其中心脏异常(室间隔缺损、房间隔缺损、动脉导管未闭、心室扩张)8例。严重异常8例(3例为18三体,2例为Cantrell五联症,1例为13三体,1例为囊性水瘤,1例为法洛四联症)。在研究的七个参数中,发现CDH和羊水时的胎龄与胎儿存活有关。结论:超声有助于预测CDH的产后预后。妊娠少于25周诊断出CDH和羊水的存在与较高的死亡率相关。在这两种情况下,产后治疗和产前手术干预是挽救胎儿所必需的。CDH患儿生存率为45%。其中55.6%有持续性发病。产前咨询应该反映这一点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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