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Am J Perinatol 2018; 35(10): 919-924
DOI: 10.1055/s-0037-1617754
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes?

Jeffrey D. Sperling
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
,
Teresa N. Sparks
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
,
Victoria K. Berger
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
,
Jody A. Farrell
3   Division of Pediatric Surgery, Department of Surgery, Fetal Treatment Center, University of California, San Francisco, San Francisco, California
,
Kristen Gosnell
3   Division of Pediatric Surgery, Department of Surgery, Fetal Treatment Center, University of California, San Francisco, San Francisco, California
,
Roberta L. Keller
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
,
Mary E. Norton
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
,
Juan M. Gonzalez
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
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Publikationsverlauf

04. Juli 2017

29. November 2017

Publikationsdatum:
05. Januar 2018 (online)

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Abstract

Objective The objective of this study was to examine laterality as a predictor of outcomes among fetuses with prenatally diagnosed congenital diaphragmatic hernia (CDH).

Methods This is a retrospective cohort study of pregnancies with CDH evaluated at our center from 2008 to 2016 compared cases with right-sided CDH (RCDH) versus left-sided CDH (LCDH). The primary outcome was survival to discharge. Secondary outcomes included ultrasound predictors of poor prognosis (liver herniation, stomach herniation, lung area-to-head circumference ratio [LHR]), concurrent anomalies, hydrops, stillbirth, preterm birth, mode of delivery, small for gestational age, use of extracorporeal membrane oxygenation, and length of stay. Terminations and stillbirths were excluded from analyses of neonatal outcomes.

Results In this study, 157 (83%) LCDH and 32 (17%) RCDH cases were identified. Survival to discharge was similar (64 vs. 66.4%, p = 0.49) with regard to laterality. RCDH had higher rates of liver herniation (90.6 vs. 72%, p = 0.03), hydrops fetalis (15.6 vs. 1.3%, p < 0.01), and lower LHR (0.87 vs. 0.99, p = 0.04). LCDH had higher rates of stomach herniation (69.4 vs. 12.5%, p < 0.01). Rates of other outcomes were similar in univariate analyses. Adjusting for microarray abnormalities, the odds for survival to discharge for RCDH compared with LCDH was 0.93 (0.38–2.30, p = 0.88).

Conclusion Compared with LCDH, fetuses with RCDH had higher rates of adverse ultrasound predictors, but equivalent survival.

Keywords

congenital diaphragmatic hernia - prenatal diagnosis - fetal - laterality - LHR - ECMO - EXIT
 

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