ANATOMIC STUDY OF THE UMBILICAL VEIN AND DUCTUS VENOSUS IN HUMAN FETUSES - ULTRASOUND APPLICATION IN PRENATAL EXAMINATION OF LEFT CONGENITAL DIAPHRAGMATIC-HERNIA

For clinicians it is very difficult to evaluate the prognosis of a lef t congenital diaphragmatic hernia (CDH) at prenatal ultrasound examina tion. Surgical studies show that the presence of a large part of the l iver in the chest is a criterion of poor prognosis. However, ultrasono graphy encounters some difficulties in determining the precise positio n of the liver in the thoracic cavity. The aim of this anatomic study was to define the relationship between the position of the liver and t he path of the ductus venosus and of the umbilical v., which are easil y recognizable at prenatal sonography. Twenty dead fetuses were used f or the study (12 with a left CDH and 8 without). All fetuses underwent radiographic assessment, anatomic dissection and cross-sectional stud y. The angle between the umbilical v. and the ductus venosus in differ ent planes was measured. The more the liver was in the thorax, the gre ater was the angle between the ductus venosus and the sagittal plane, and the less the angle between the ductus venosus and the umbilical v. These angles can be easily measured by prenatal ultrasound examinatio n of the fetus. Our findings suggest that it is now possible to offer the clinician a new and reliable way to determine the prognosis of a l eft CDH before birth.