FETAL CONGENITAL DIAPHRAGMATIC-HERNIA - ACCURACY OF SONOGRAPHY IN THEDIAGNOSIS AND PREDICTION OF THE OUTCOME AFTER BIRTH

OBJECTIVE. This study evaluated the diagnostic accuracy of prenatal so nography in congenital diaphragmatic hernia (CDH) and assessed sonogra phic predictors of postnatal outcome. MATERIALS AND METHODS. Sonograms and medical records of 43 fetuses with CDH were retrospectively revie wed. Sonographic features were correlated to clinical evolution and su rgical and pathologic findings. RESULTS. CDH was diagnosed prenatally with sonography in 40 cases, Intrathoracic stomach and liver were rout inely identified, Ipsilateral lung tissue could not be differentiated from herniated content, Contralateral lung was identified in all cases except two. The overall survival rate was 43% after excluding termina ted pregnancies. Besides associated malformations and chromosomal anom alies, the only statistically significant predictor of survival was th e quantification of the contralateral lung area at the level of an axi al four-chamber view: The survival rate was 86% when the contralateral lung area was equal to or greater than one half the area of the hemit horax, CONCLUSION. Sonography is highly accurate for prenatal diagnosi s of CDH, Sonography also assists the prognostication of postnatal out come in isolated CDH by allowing quantification of the contralateral l ung area on a four-chamber view.