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Advisor(s)
Abstract(s)
Objectives To evaluate the accuracy and probabilities of
different fetal ultrasound parameters to predict neonatal
outcome in isolated congenital diaphragmatic hernia
(CDH).
Methods Between January 2004 and December 2010, we
evaluated prospectively 108 fetuses with isolated CDH
(82 left-sided and 26 right-sided). The following parameters
were evaluated: gestational age at diagnosis, side
of the diaphragmatic defect, presence of polyhydramnios,
presence of liver herniated into the fetal thorax (liverup),
lung-to-head ratio (LHR) and observed/expected
LHR (o/e-LHR), observed/expected contralateral and
total fetal lung volume (o/e-ContFLV and o/e-TotFLV)
ratios, ultrasonographic fetal lung volume/fetal weight
ratio (US-FLW), observed/expected contralateral and
main pulmonary artery diameter (o/e-ContPA and o/e-
MPA) ratios and the contralateral vascularization index
(Cont-VI). The outcomes were neonatal death and severe
postnatal pulmonary arterial hypertension (PAH).
Results Neonatal mortality was 64.8% (70/108). Severe
PAH was diagnosed in 68 (63.0%) cases, of which 63
died neonatally (92.6%) (P < 0.001). Gestational age at
diagnosis, side of the defect and polyhydramnios were
not associated with poor outcome (P > 0.05). LHR, o/e-
LHR, liver-up, o/e-ContFLV, o/e-TotFLV, US-FLW, o/e-
ContPA, o/e-MPA and Cont-VI were associated with both
neonatal death and severe postnatal PAH (P < 0.001).
Receiver–operating characteristics curves indicated that
measuring total lung volumes (o/e-TotFLV and USFLW)
was more accurate than was considering only
the contralateral lung sizes (LHR, o/e-LHR and o/e-
ContFLV; P < 0.05), and Cont-VI was the most accurate
ultrasound parameter to predict neonatal death and severe
PAH (P < 0.001).
Conclusions Evaluating total lung volumes is more
accurate than is measuring only the contralateral lung
size. Evaluating pulmonary vascularization (Cont-VI)
is the most accurate predictor of neonatal outcome.
Estimating the probability of survival and severe PAH
allows classification of cases according to prognosis.
Description
Keywords
3D ultrasonography Congenital diaphragmatic hernia Power Doppler Pulmonary hypoplasia Three-dimensional ultrasonography
Citation
Ultrasound in Obstetrics & Gynecology, 39, 42-49