Antenatal management and outcomes of pregnancies with congenital diaphragmatic hernia

Article type: Research Article

Authors: Tanacan, Atakan^{a; *} | Orgul, Gokcen^a | Aydin, Emine^a | Kayki, Gozdem^b | Celik, Hasan Tolga^b | Yalcin, Sule^c | Soyer, Tutku^c | Yigit, Sule^b | Yurdakok, Murat^b | Beksac, Mehmet Sinan^a

Affiliations: [a] Department of Obstetric and Gynecology, Division of Perinatology, Hacettepe University Hospital, Ankara, Turkey | [b] Department of Pediatrics, Division of Neonatology, Hacettepe University Hospital, Ankara, Turkey | [c] Department of Pediatric Surgery, Hacettepe University Hospital, Ankara, Turkey

Correspondence: [*] Address for correspondence: Atakan Tanacan, Hacettepe University Hospital, Division of Perinatology, Department of Obstetrics and Gynecology, Sihhiye/Ankara, Postal code: 06100, Turkey. Tel.: +90 5323530892; Fax: +90 3123051910; E-mail: [email protected].

Abstract: BACKGROUND:The objective of this study is to evaluate the obstetric outcomes of pregnancies with congenital diaphragmatic hernia (CDH). METHODS:Fifty one pregnancies prenatally diagnosed with CDH at our institution between January 1, 2002 and August 31, 2018 were retrospectively evaluated. The pregnancies were divided into two groups according to neonatal survival. Demographic features, clinical characteristics and prognostic factors were compared between the neonatal survival (n = 16) and non-survival (n = 28) groups. Cut-off values of fetal lung area to head circumference ratio (LHR), observed/expected LHR (o/e LHR) and observed/expected total fetal lung volume (o/e TFLV) for neonatal survival were calculated. RESULTS:Thirty six (70.6%) and fifteen (29.4%) fetuses had left and right sided CDH respectively. Seven patients chose termination of their pregnancies (13.7%). Statistically significant differences were found between survival and non-survival groups in terms of parity, median gestational week at diagnosis, polyhydroamniosis rate, CDH type, stomach position, liver position, median LHR, o/e LHR, o/e TFLV, median 5th minute Apgar score and neonatal operation rate values (p values were 0.03,<0.001, 0.02, 0.006,<0.001, 0.006,<0.001,<0.001,<0.001, 0.04 and <0.001 respectively). According to ROC curve analysis, 1.05 (82% sensitivity, 74% specificity) for LHR, 22.5 (78.6% sensitivity, 73.9% specifity) for o/e LHR and 23.5 (85.7% sensitivity,74.2% specificity) for o/e TFLV were determined to be cut-offs for neonatal survival, respectively, with highest sensitivity and specificity. CONCLUSION:Earlier gestational week at diagnosis, right sided CDH, presence of liver herniation, supradiaphragmatic stomach position, lower LHR, o/e LHR and o/e TFLV were associated with decreased rates of neonatal survival.

Keywords: Congenital diaphragmatic hernia, prenatal prognostic factors, total fetal lung volume, neonatal mortality, lung to head ratio

DOI: 10.3233/NPM-190266

Journal: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 3, pp. 323-330, 2020