Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
Singapore Med J. 2013 Aug;54(8):432-6. doi: 10.11622/smedj.2013149.
We aimed to investigate the epidemiology, diagnosis, prognostication, follow-up care and outcomes of antenatally diagnosed congenital diaphragmatic hernia (CDH) in KK Women's and Children's Hospital (KKH), Singapore. The objective of this study was to identify trends in current practice, and evaluate and improve the management of CDH.
We retrospectively reviewed cases of antenatally diagnosed CDH from 2006 to 2010.
A total of 22 cases of CDH were found, bringing its incidence in KKH to 3.6 per 10,000 live births. The mean gestational age at diagnosis was 22.7 weeks, with 14 (63.6%) cases diagnosed at < 22 weeks and 8 (36.4%) diagnosed at ≥ 22 weeks. All cases were left-sided - 15 (68.2%) were isolated CDH and 7 (31.8%) were associated with other anomalies. Of the 22 cases, counselling about the prognosis of pregnancy based on the lung-to-head ratio was provided in 9 (40.9%). Overall, 10 (45.5%) cases resulted in termination of pregnancy (TOP), 9 (40.9%) resulted in live birth and 1 (4.5%) in stillbirth; 2 (9.1%) cases were lost to follow-up prior to delivery. Of the 9 live births, 3 (33.3%) resulted in neonatal death. In the 10 births, 5 (50.0%) were delivered by normal vaginal delivery, 4 (40.0%) by emergency Caesarean section and 1 (10.0%) by elective Caesarean section.
CDH is a challenging perinatal problem with a low overall survival rate. Almost half of the cases opt for TOP. The data in this study can help clinicians better undertake the task of adequately counselling parents with qualitative and quantitative prognostic factors, using an evidence-based approach.
我们旨在研究新加坡 KK 妇女儿童医院（KKH）产前诊断先天性膈疝（CDH）的流行病学、诊断、预后、随访护理和结局。本研究的目的是确定当前实践的趋势，并评估和改进 CDH 的管理。
我们回顾性分析了 2006 年至 2010 年期间产前诊断为 CDH 的病例。
共发现 22 例 CDH，使 KKH 的发病率达到每 10000 例活产儿 3.6 例。诊断时的平均孕周为 22.7 周，其中 14 例（63.6%）在<22 周时诊断，8 例（36.4%）在≥22 周时诊断。所有病例均为左侧，15 例（68.2%）为孤立性 CDH，7 例（31.8%）与其他畸形有关。在 22 例中，有 9 例（40.9%）根据肺头比提供了妊娠预后咨询。总体而言，10 例（45.5%）导致终止妊娠（TOP），9 例（40.9%）导致活产，1 例（4.5%）导致死产；2 例（9.1%）在分娩前失访。在 9 例活产中，3 例（33.3%）新生儿死亡。在 10 例分娩中，5 例（50.0%）经阴道正常分娩，4 例（40.0%）经紧急剖宫产，1 例（10.0%）经择期剖宫产。
CDH 是一种具有挑战性的围产期问题，总体存活率较低。近一半的病例选择 TOP。本研究中的数据可以帮助临床医生更好地通过基于证据的方法，用定性和定量的预后因素充分为父母提供咨询。
