P30.18: Prenatal diagnosis of left posterolateral congenital diaphragmatic hernia with ileal loops—antepartum management and postpartum therapy

Abstract

A 35 year old woman with a previous child with trisomy 21 was admitted at 22 weeks for an US scan at which the fetus appeared normal excepting for dextrocardia and dyshomogeneous left hemithorax. For the relatively high risk (5–15%) for trisomy 18 and 21 of a possible CDH we performed amniocentesis. The kariotype was normal, 46XY. The next scan at 28 weeks showed again dextrocardia, normal stomach, diaphragm with loosed hypoechoic contour on the left side, the left hemithorax with scattered small hypoechoic areas and apparent movements. This excluded the cystic adenomatoid malformation of the lung and confirms the CDH. A thorough scan was conducted in order to exclude the non-chromosomal syndromes associated with CDH (Fryns, Beckwith-Wiedemann, Pallister) and the result was normal. For left sided congenital diaphragmatic hernias the lung-to-head ratio has proved to be an indicator with good prognostic value. In our case LHR was 1.4, that means a high survival rate, and this value was maintained throughout the rest of the pregnancy. The prognosis is dependent on the degree of pulmonary hypoplasia and the subsequent pulmonary hypertension. At 40 weeks the patient delivered by caesarean section a 2900 g boy that was immediately gentle ventilated and transferred to a neonatal surgery unit where was performed at 48 hours after birth a surgical repair of the diaphragmatic defect by tissue approximation with excellent result. For left sided CDH survival rates are around 50–60% with good quality of life. Supporting information can be found in the online version of this abstract. Dextrocardia and ileal loops. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.