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217: Prenatal diagnosis of congenital diaphragmatic hernia: does laterality predict adverse perinatal outcomes?

      Objective

      To examine laterality as a predictor of adverse perinatal outcomes among fetuses with prenatally diagnosed congenital diaphragmatic hernia (CDH).

      Study Design

      This is a retrospective cohort study of pregnancies with fetal CDH that were evaluated at our institution’s Fetal Treatment Center from 2008 to 2016. Cases with right- versus left-sided CDH were compared. Outcomes examined included lung to head ratio (LHR), liver and stomach herniation, presence of additional anomalies, amniotic volume, hydrops, specific fetal cavity with abnormal fluid collection, intrauterine fetal demise (IUFD), gestational age (GA) at birth, birth weight, mode of delivery, use of extracorporeal membrane oxygenation (ECMO), neonatal days to discharge, and survival to discharge. Cases resulting in termination or IUFD were excluded from analyses of neonatal outcomes. Categorical variables were compared with the Fisher’s exact or Chi square test as appropriate, nonparametric continuous variables were compared using Wilcoxon rank-sum, and multivariate logistic regression was used to generate adjusted odds ratios (aOR).

      Results

      Of the 191 CDH cases identified during the study period, 157 (82%) were left-sided and 34 (18%) were right-sided. Compared to left-sided CDH cases, those with right-sided CDH had a greater risk of liver herniation, ascites, pleural effusion, and hydrops, and demonstrated a lower median LHR (Table). In contrast, cases with left-sided CDH showed a greater risk of stomach herniation. Other perinatal outcomes did not differ by laterality (Table). For right-sided CDH, multivariate logistic regression yielded adjusted odds ratios of 3.9 (p=0.032) for liver herniation, 11.8 (p=0.001) for ascites, 9.0 (p=0.004) for pleural effusion, 14.8 (p=0.002) for hydrops, and 0.06 (p<0.001) for stomach herniation.

      Conclusion

      When compared to left-sided CDH, fetuses with right-sided CDH were more likely to have liver herniation, ascites, pleural effusion, and hydrops, and to have a lower LHR. Increased antenatal surveillance is warranted in cases of right-sided CDH to monitor for development of these outcomes.
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