Fetal Outcomes of Prenatally Diagnosed Congenital Diaphragmatic Hernia: Nine Years of Clinical Experience in a Canadian Tertiary Hospital

Abstract

Objective: To summarize the clinical outcome of congenital diaphragmatic hernia (CDH) identified on prenatal ultrasound.

Method: We reviewed prenatally detected cases of CDH diagnosed between July 2000 and September 2009 at a single tertiary-care facility.

Results: Ninety-one cases were identified. Sixty-nine cases had complete medical records including karyotype. Of these, 40 were isolated defects and 29 cases had additional congenital or chromosome anomalies. An abnormal karyotype was present in 17.4% overall, affecting 2.5% of cases of isolated CDH (1/40) and 37.9% of cases of non-isolated CDH (11/29). The rate of termination of pregnancy in cases of isolated CDH diagnosed prior to 24 weeks was 33.3% (10/30), and in cases of non-isolated CDH it was 73.9% (17/23). The survival rate of the 44 liveborn infants was 66.7% (24/36) for those with isolated CDH and 37.5% (3/8) for those with non-isolated CDH. The decision to terminate the pregnancy was made in 73.9% of fetuses with prenatally diagnosed karyotype or additional anatomical abnormalities, in contrast to 37.5% of prenatally diagnosed isolated CDH.

Conclusion: The outcomes of pregnancies that continue after identification of CDH are in keeping with previous reports, with an overall survival rate of 61.4%. The presence of additional anatomical anomalies was the only predictor of mortality among liveborn infants.

Keywords: CDH; congenital diaphragmatic hernia; fetal malformation; outcome; pregnancy.