Fetal congenital diaphragmatic hernia: ultrasound diagnosis possibilities and prediction of postnatal outcome
- Autores: Demidov V.N.1, Mashinets N.V.1, Podurovskaya U.L.1, Burov A.A.1
-
Afiliações:
- Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
- Edição: Nº 4 (2014)
- Páginas: 38-45
- Seção: Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/247156
- ID: 247156
Citar
Texto integral
Acesso aberto
Acesso está concedido
Acesso é pago ou somente para assinantes
Resumo
Objective. To estimate the possibility of using echography to predict postnatal outcome in fetal congenital diaphragmatic hernia (CDH). Subject and methods. Seventy-three fetal CDH cases were analyzed. Sixty-six fetuses had left-sided hernia, 5 had right-sided hernia, and 2 had bilateral hernia. Results. The major echographic signs of CDH were cardiac compression and displacement contralateral to the diaphragmatic defect, as well as the appearance of abdominal viscera in the chest. In bilateral diaphragmatic hernia, the liver was detectable on the right side next to the heart and the intestinal loops and stomach were placed on the left. Antenatal fetal death occurred in 2 cases; termination of pregnancy did in 8. Out of 63 born neonates, 44 (70%) were operated on; 19 (30%) died preoperatively. Postoperative survival was 86%; mortality was 14%. For the prediction of postnatal outcome in fetal CDH, we proposed a new prognostic criterion, such as cardiac compression index (CCI) based on the fact that in CDH, by penetrating into the chest, the abdominal organs compress the heart, by increasing its length and decreasing its thickness. With a CCI of less than 1.5, the postnatal neonatal status was mild and moderate in 79%; with that of 1.5 or more, it was severe and extremely severe in 91%. Conclusion. Prenatal echography is a valuable technique, the use of which enables us to predict the neonatal status in fetal CDH with a high degree of accuracy.
Palavras-chave
Texto integral
Sobre autores
Vladimir Demidov
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: v_demidov@oparina4.ru
MD, professor, the chief researcher of the department of functional diagnostics
Natalya Mashinets
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: natashamashinets@yandex.ru
PhD, the senior researcher of the department of functional diagnostics
Ulya Podurovskaya
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: y_podurovskaya@oparina4.ru
PhD, the chief of the department of surgery, resuscitation and intensive therapy of the newborns of the division of neonatology and pediatrics
Artem Burov
Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: a_burov@oparina4.ru
anesthesiologist- resuscitator, the department of surgery, resuscitation and intensive therapy of the newborns of the division of neonatology and pediatrics
Bibliografia
- Пороки развития диафрагмы. В кн.: Исаков Ю.Ф., Володин Н.Н., Гераськин А.В., ред. Неонатальная хирургия. М.: Династия; 2011: 332-58
- Юдина Е.В. Легкие. В кн.: Медведев М.В., ред. Пренатальная эхография. М.: Реальное Время; 2005: 341-71
- Некрасова Е.С. Пренатальная ультразвуковая диагностика и тактика ведения беременности при диафрагмальной грыже плода. Ультразвуковая и функциональная диагностика. 2011; 2: 47-56
- Garne E., Haeusler M., Barisic I., Gjergja R., Stott C., Oementi M.; Euroscan Study Group. Congenital diaphragmatic hernia: evaluation of prenatal diagnosis in 20 European regions. Ultrasound Obstet. Gynecol. 2002; 19(4): 329-33
- Гусева О.И. Перинатальные исходы и прогноз при диафрагмальной грыже. Ультразвуковая и функциональная диагностика. 2005; 6: 19-27
- Пуйда С.А. Ультразвуковая пренатальная диагностика врожденных аномалий органов дыхания: Автореф. дис. ... канд. мед. наук. СПб.; 2007. 16 с
- Gucciardo L., Deprest J., Done’ E., Van Mieghem T., Van de Velde M., Gratacos E. et al. Prediction of outcome in isolated congenital diaphragmatic hernia and its consequences for fetal therapy. Best Pract. Res. Clin. Obstet. Gynaecol. 2008; 22(1): 123-38
- Eroglu D., Yanik F., Sakallioglu A.E., Arikan U., Varan B., Kuscu E. Prenatal diagnosis of bilateral diaphragmatic hernia by fetal sonography. J. Obstet. Gynaecol. Res. 2006; 32(1): 90-3.
- Song M.S., Yoo S.J., Smallhorn J.F., Mullen J.B., Ryan G., Hornberger L.K. Bilateral congenital diaphragmatic hernia: diagnostic clues at fetal sonography. Ultrasound Obstet. Gynecol. 2001; 17(3): 255-8.
- Rais-Bahrami K., Hsiao D., Short B.L., Baumgart S. Bilateral congenital diaphragmatic agenesis. J. Neonatal Perinatal Med. 2008; 1(1): 59-62.
- Bedoyan J.K., Blackwell S.C., Treadwell M.C., Johnson A., Klein M.D. Congenital diaphragmatic hernia: associated anomalies and antenatal diagnosis. Outcome-related variables at two Detroit hospitals. Pediatr. Surg. Int. 2004; 20(3): 170-6.
- Jani J., Keller R.L., Benachi A., Nicolaides K.H., Favre R., Gratacos E.; Antenatal-CDH-Registry Group. Prenatal prediction of survival in isolated left-sided diaphragmatic hernia. Ultrasound Obstet. Gynecol. 2006; 27(1): 18-22.
- Heling K.S., Wauer R.R., Hammer H., Bollmann R., Chaoui R. Reliability of the lung-to-head ratio in predicting outcome and neonatal ventilation parameters in fetuses with congenital diaphragmatic hernia. Ultrasound Obstet. Gynecol. 2005; 26(2): 112-8.
- Sharland G.K., Lockhart S.M., Heward A.J., Allan L.D. Prognosis in fetal diaphragmatic hernia. Am. J. Obstet. Gynecol. 1992; 166(1, Pt1): 9-13.
- Metkus A.P., Filly R.A., Stringer M.D., Harrison M.R., Adzick N.S. Sonographic predictor of survival in fetal diaphragmatic hernia. J. Pediatr. Surg. 1996; 31(1): 148-51.
- Jani J., Nicolaides K.H., Keller R.L., Benachi A., Peralta C.F., Favre R. et al.; Antenatal-CDH-Registry Group. Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet. Gynecol. 2007; 30(1): 67-71.
- Deprest J.A., Flemmer A.W., Gratacos E., Nicolaides K. Antenatal prediction of lung volume and in-utero treatment by fetal endoscopic tracheal occlusion in severe isolated congenital diaphragmatic hernia. Semin. Fetal Neonatal Med. 2009; 14(1): 8-13.
- Harrison M.R., Keller R.L., Hawgood S.B., Kitterman J.A., Sandberg P.L., Farmer D.L. et al. A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. N. Engl. J. Med. 2003; 349(20): 1916-24.
- Щитинин В.Е., Арапова А.В., Мельникова Н.И., Е.В. Карцева Е.В., Кузнецова Е.В. Врожденная диафрагмальная грыжа у новорожденных группы высокого риска. Российские медицинские вести. 2004; 3: 57-9.
- Патент - 2476156 РФ, МПК А61 В 8/06. Способ пренатального прогнозирования состояния новорожденного с врожденной диафрагмальной грыжей. В.Н. Демидов, Н.В. Машинец, Ю.И. Кучеров, Ю.В. Жиркова, А.А. Буров; ФГБУ НЦАГиП им. В.И. Кулакова Министерства здравоохранения и социального развития РФ. N 2011139531/14; Заявлено 29.09.2011; Опубл. 27.02.2013, Бюл. N 6
Arquivos suplementares
