[Changes in the perinatal management of congenital diaphragmatic hernia in the last 15 years' experience of our institute].

AIM

Review of perinatally diagnosed congenital diaphragmatic hernia cases with regard to time of diagnosis, side of hernia, mode of delivery, organs herniated into the thorax, main group of associated malformations and the outcome.

MATERIAL AND METHOD

The authors analysed the data of 104 cases from records of I. Department of Obstetrics and Gynecology Semmelweis University Budapest between July 1, 1990 and June 30, 2005. The observed period was analysed in two parts.

RESULTS

Prenatal ultrasound was performed in 93 cases. In 6 cases (6.5%) the prenatally diagnosed congenital diaphragmatic hernia postnatally proved to be a different non-cardiac thoracic malformation. 50.4% of the pre- and postnatally verified 87 congenital diaphragmatic hernia cases were diagnosed before the 24th week of gestation. 11 hernias were identified postnatally. From the diagnosed 98 cases 69 (70.4%) occurred as a part of multiple anomalies. The hernia was left-sided in 86.7%, and both-sided in 4 cases. In 1990-1997, the percentage of right-sided hernia was 4% while in the second period it was 13%. Delivery was performed in 51 cases, with prenatal diagnosis in 40 cases. From the 51 newborns 14 were alive, thus the survival rate was 27.5%. The survival rate of the newborns delivered by cesarean section was three times higher than that of the vaginally delivered ones. There was termination in 38 cases, 6 of which were isolated malformation. Intrauterine or subpartu death occurred in 5 cases. We have no data about the outcome of the pregnancy in four cases. The liver, spleen and stomach thoracic herniation was twice as high in the second period as it was in the first period, but their correlation did not change.

CONCLUSION

According to the analysis of the 15 years' data the herniated organs, the multiplex malformations as well as the mode of delivery influence the survival in a large number of cases. Early diagnosis portends a large hernia, a higher malformation rate, and the worse prognosis.