Antenatal diagnosis of congenital diaphragmatic hernia.

Abstract

The mortality rate in cases of antenatally diagnosed congenital diaphragmatic hernia (CDH) remains high: 80% to 100% mortality was reported in early series and 73% in a more recent series. In addition, the early reports described 100% mortality for cases diagnosed before 24 weeks gestational age. To determine the mortality rate in patients at their institution (a specialized tertiary-care hospital), the authors reviewed 11 cases of CDH diagnosed from 1987 to 1990, for all of which antenatal ultrasonography (US) had been performed at the hospital. Overall, 7 of the 11 patients survived. In seven of the cases the condition had been diagnosed antenatally. Of these patients, four survived, including two of the three in whom the diagnosis had been made before 21 weeks gestational age. All four false-negative cases involved a right-side hernia, and in three of these the prenatal US examinations had been performed before 16 weeks gestational age. Three of these four patients survived. This study suggests that the prognosis in antenatally diagnosed CDH is improving and confirms that this condition is not uniformly fatal in cases diagnosed before 24 weeks gestational age.