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Year : 2016  |  Volume : 9  |  Issue : 1  |  Page : 149-150  

Anesthetic management of a case of congenital diaphragmatic hernia; delayed diagnosis

Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, and Research Centre, Pimpri, Pune, Maharashtra, India

Date of Web Publication22-Dec-2015

Correspondence Address:
Dhaval K Thakkar
403, Alaknanda, Neelkanth Valley, Ghatkopar East, Mumbai - 400 077, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-2870.150499

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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

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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 8];9:149-50. Available from:


To complement the case report Anesthetic management of a case of congenital diaphragmatic hernia (CDH); delayed diagnosis by Joshi and George, [1] 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. [2] Most babies born with CDH die after birth with a survival rate of 67%. [3],[4] 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. [5] 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. [5] Singh et al. found in their studies that 50% of CDH patients which were diagnosed with antenatal diagnosis before 25 weeks survived. [6]

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. [7] 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. [3] 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). [3] 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. [3]

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. [8] 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. [5] 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. [5]

  References Top

Joshi S, George A. Anesthetic management of a case of congenital diaphragmatic hernia; delayed diagnosis. Med J DY Patil Univ 2013;6:281-3.  Back to cited text no. 1
  Medknow Journal  
Graham G, Devine PC. Antenatal diagnosis of congenital diaphragmatic hernia. Semin Perinatol 2005;29:69-76.  Back to cited text no. 2
Adzick NS, Harrison MR, Glick PL, Nakayama DK, Manning FA, deLorimier AA. Diaphragmatic hernia in the fetus: Prenatal diagnosis and outcome in 94 cases. J Pediatr Surg 1985;20:357-61.  Back to cited text no. 3
Haroon J, Chamberlain RS. An evidence-based review of the current treatment of congenital diaphragmatic hernia. Clin Pediatr (Phila) 2013;52:115-24.  Back to cited text no. 4
Kotecha S, Barbato A, Bush A, Claus F, Davenport M, Delacourt C, et al. Congenital diaphragmatic hernia. Eur Respir J 2012;39:820-9.  Back to cited text no. 5
Singh SJ, Cummins GE, Cohen RC, Cass D, Harvey JG, Martin HC, et al. Adverse outcome of congenital diaphragmatic hernia is determined by diaphragmatic agenesis, not by antenatal diagnosis. J Pediatr Surg 1999;34:1740-2.  Back to cited text no. 6
O'Mahony E, Stewart M, Sampson A, East C, Palma-Dias R. Perinatal outcome of congenital diaphragmatic hernia in an Australian tertiary hospital. Aust N Z J Obstet Gynaecol 2012;52:189-94.  Back to cited text no. 7
Bronshitein M, Lewit N, Sujov PO, Makhoul IR, Blazer S. Prenatal diagnosis of congenital diaphragmatic hernia: Timing of visceral herniation and outcome. Prenat Diagn 1995;15:695-8.  Back to cited text no. 8


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