Fetal liver position and perinatal outcome for congenital diaphragmatic hernia.


Journal Article

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.

Full Text

Cited Authors

  • Albanese, CT; Lopoo, J; Goldstein, RB; Filly, RA; Feldstein, VA; Calen, PW; Jennings, RW; Farrell, JA; Harrison, MR

Published Date

  • November 1998

Published In

Volume / Issue

  • 18 / 11

Start / End Page

  • 1138 - 1142

PubMed ID

  • 9854721

Pubmed Central ID

  • 9854721

Electronic International Standard Serial Number (EISSN)

  • 1097-0223

International Standard Serial Number (ISSN)

  • 0197-3851

Digital Object Identifier (DOI)

  • 10.1002/(sici)1097-0223(199811)18:11<1138::aid-pd416>3.0.co;2-a


  • eng