Extracorporeal life support for nonimmune hydrops fetalis

Congenital diaphragmatic hernia and hydrops: a lethal association?

BACKGROUND/PURPOSE

Nonimmune hydrops in the fetus is a finding that often portends death. The association and prognosis of fetuses with congenital diaphragmatic hernia (CDH) and hydrops is not known.

METHODS

A retrospective review of all prenatally diagnosed cases and referrals of CDH was performed. Variables analyzed included gestational age at diagnosis and delivery, side of hernia, presence of associated anomalies and hydrops, and neonatal outcome.

RESULTS

Since 1993, 474 prenatal referrals for CDH have been made. One hundred seventy-five were evaluated; 15 fetuses had hydrops (9%). Five patients had CDH, hydrops, and associated lethal anomalies. In the remaining 10 patients, 6 of the diaphragmatic defects were right-sided and 4 were left-sided. All except one had a major portion of the liver herniated into the chest. Six fetuses had prenatal intervention. Five neonates died shortly after birth. There were 5 long-term survivors; all received prenatal intervention.

CONCLUSIONS

The association of CDH and hydrops is rare but often results in fatality. Hydrops appears to be associated with liver in the hernia, right-sided lesions, and lethal anomalies. Fetal intervention can be performed successfully in patients with CDH and hydrops, and may improve long-term survival rate in this group.

Hydrops fetalis

Although most NIH fetuses have poor prognosis, it is imperative to attempt to identify the underlying cause to present parents with the best estimate for prognosis and future outcomes. Identification of a disorder with a good prognosis may prevent unnecessary termination of pregnancy and give a chance for therapy. Identification of a disorder with poor prognosis may still provide information that may be unavailable after delivery regarding this and future pregnancies.