Fetal liver position and perinatal outcome for congenital diaphragmatic hernia

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Abstract
Despite advances in postnatal care, patients born with a congenital diaphragmatic hernia (CDH) suffer substantial morbidity and mortality. The present study was undertaken to determine the prognostic influence of prenatally‐diagnosed liver herniation in the hemithorax in fetuses with CDH. The medical records of 48 patients evaluated for a prenatally‐diagnosed left CDH were retrospectively reviewed. Patients were analysed according to the position of the liver by prenatal ultrasound; 32 fetuses had a major portion of the liver herniated into the left hemithorax (‘liver up’) and 16 had an intra‐abdominal liver (‘liver down’). Liver position was determined using colour‐flow Doppler ultrasonography. There were two fetal deaths in the liver‐up group and one in the liver‐down group. The liver‐up group more frequently required extracorporeal membrane oxygenation (ECMO) support (53 per cent) compared with the liver‐down group (19 per cent). Postnatal survival was significantly less in the liver‐up group (43 per cent) vs. the liver‐down group (93 per cent). Fetuses with congenital diaphragmatic hernia and liver herniated into the hemithorax have a much worse prognosis than similarly afflicted fetuses without liver herniation. Prenatal ultrasonographic diagnosis of congenital diaphragmatic hernia allows for preparation for a critically ill newborn and aids in prenatal family counselling. Copyright © 1998 John Wiley & Sons, Ltd.