Congenital diaphragmatic (Bochdalek) hernia of the fetus

Abstract

Congenital diaphragmatic hernia (CDH) is a developmental malformation characterized by a defect in the diaphragm that allows abdominal viscera to move into the chest cavity. A routine ultrasound screening performed during pregnancy detects over half of all cases. This paper describes two women who were prenatally diagnosed to have a fetus with isolated posterolateral CDH. Both mothers underwent medical abortion. In the first case, a postmortem examination of the fetus revealed a large right-sided CDH, in which a part of the liver and small intestine were propagated into the chest. In the second one, a huge left-sided CDH was identified, in which the entire stomach, a large proportion of the small intestine and part of the left lobe of the liver were pushed up into the thoracic cavity. CDH is a diagnostically challenging birth defect with a marked variation in severity and corresponding survival. In utero-diagnosed cases usually represent more severe and prognostically unfavorable conditions than those that were postnatally diagnosed. Early prenatal detection of CDH may help improve the clinical outcome as the mother can be referred to a specialist center before the onset of labor for optimal perinatal management. A legal medical abortion should be the last option after all the others have been exhausted.