Comparing the perinatal outcome in antenatally diagnosed congenital diaphragmatic hernia: epidemiological vs. tertiary referral data

Abstract

We set out to compare the perinatal outcome in cases of antenatally diagnosed congenital diaphragmatic hernia (CDH) referred to a tertiary fetal medicine centre with that in cases reported to the Regional Congenital Anomalies Register (CAR) and also compare it with previously published data. This was a retrospective study of 28 consecutive cases of CDH diagnosed antenatally and referred to the pregnancy assessment centre from 1993 to 2000 and of 41 antenatally reported cases in the Trent Region from 1997 to 2000. In the tertiary referral cases, of the 28 cases, three had a termination of pregnancy (10.7%). Of the 25 cases (89.3%) that continued, one had an intrauterine death (4%) and there were seven neonatal deaths (28%). Seventeen babies survived to operation (68%) and there were no postoperative deaths. In comparison, of the 43 cases reported to CAR, 16 had a termination of pregnancy (37.2%). Of the 27 cases that continued, there was one spontaneous miscarriage, three intrauterine deaths (11.5%) and 14 neonatal deaths without surgery (53.8%). Nine babies survived to operation (34.6%) and there were five postoperative deaths (55.5%). The survival (excluding termination cases) was 68% in the tertiary referral centre compared to 15.3% in the Regional cases. The MEDLINE search showed survival (excluding termination cases) ranging from 12 to 65%, with termination rates varying from 7 to 44%. The postoperative mortality ranged from 11 to 70%. Most of these publications were from tertiary referral units.