|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 1 | Page : 149-150
Anesthetic management of a case of congenital diaphragmatic hernia; delayed diagnosis
Dhaval K Thakkar, Amit Kharat, Amarjit Singh, VM Kulkarni
Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, and Research Centre, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||22-Dec-2015|
Dhaval K Thakkar
403, Alaknanda, Neelkanth Valley, Ghatkopar East, Mumbai - 400 077, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Thakkar DK, Kharat A, Singh A, Kulkarni V M. Anesthetic management of a case of congenital diaphragmatic hernia; delayed diagnosis. Med J DY Patil Univ 2016;9:149-50
|How to cite this URL:|
Thakkar DK, Kharat A, Singh A, Kulkarni V M. Anesthetic management of a case of congenital diaphragmatic hernia; delayed diagnosis. Med J DY Patil Univ [serial online] 2016 [cited 2020 Aug 5];9:149-50. Available from: http://www.mjdrdypu.org/text.asp?2016/9/1/149/150499
To complement the case report Anesthetic management of a case of congenital diaphragmatic hernia (CDH); delayed diagnosis by Joshi and George,  we would like to highlight the importance of antenatal ultrasonography for diagnosis of CDH.
Congenital diaphragmatic hernia occurs in approximately 1 of 2200 live births and is associated with high degree of morbidity and mortality.  Most babies born with CDH die after birth with a survival rate of 67%. , Therefore, antenatal diagnosis plays a vital role for its diagnosis and early intrauterine management to reduce mortality. In the prenatal period, antenatal ultrasonography has a high sensitivity (>70%) in the detection of CDH.  The key feature of note on the ultrasound images is presence of bowel loops peristalsis in the chest. Ultrasonographic lung size assessment is best undertaken by the use of the observed/expected lung-to-head ratio.  Singh et al. found in their studies that 50% of CDH patients which were diagnosed with antenatal diagnosis before 25 weeks survived. 
O'Mahony et al. found that CDH is a potentially correctable anatomical defect that continues to represent a significant cause of stillbirth and neonatal death.  In the study by Adzick et al. they found that most fetuses with detectable CDH died in the neonatal period (80% mortality), despite optimal conventional therapy.  Adzick et al. also commented on presence of polyhydramnios, which was both a common prenatal marker for CDH (present in 76% of fetuses) and a predictor for poor clinical outcome (only 11% survived).  Polyhydramnious is easily detected on antenatal ultrasound and can alert the sonologist regarding associated congenital anomalies. Fetus with CDH and polyhydroaminos if surgically intervened before birth can lead to improvement of their survival. 
Bronshitein et al. in their study suggested that the timing of visceral herniation into the thoracic cavity is also a major indicator for the prognosis of fetuses. They stated 46% of them who were diagnosed CDH before 16 weeks were aborted while 13% which were diagnosed 21-23 weeks gestation died after surgical repair. In contrast, 40% of infants whose visceral herniation was diagnosed after 24 weeks of gestation, and whose sonographic studies at 15-23 weeks had been normal, were alive and well after corrective surgery.  Thus normal sonographic studies during the first half of pregnancy do not exclude the subsequent development of CDH, and thereby stating the importance of serial sonography examinations during the later stages of gestation.
Kotecha et al. concluded that in all cases, delivery should be planned at a tertiary perinatal center; in those with a poor prognosis (e.g., having other congenital abnormalities), termination of pregnancy may be considered. And for isolated CDH, antenatal therapy is an option.  Therefore, antenatal counseling is essential and should be conducted by a multidisciplinary team. Amniocentesis and genetic consultation to screen for chromosomal anomalies are advised due to its association with other congenital anomalies. 
| References|| |
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