Prenatal diagnosis and postnatal outcome of congenital diaphragmatic hernia: experiences from Vietnamese tertiary centres

The study aims to report the experiences in prenatal diagnosis, postnatal management, and outcomes of CDH patients at two tertiary centres. An observational study retroactively reviewed the prenatal diagnosis of CDH from 2021 to 2022 at the Prenatal Diagnosis and Neonatal Screening Center, HOGH. Primary endpoints were the rate of associated genetic abnormalities, pregnancy continuation, postnatal surgeries, and survival rates. 46 fetuses were prenatally diagnosed with CDH by ultrasound. Five cases (10.9%) decided to terminate, with 41 cases following the pregnancy to term (89.1%). The timing of CDH diagnosis ranged from 13 to 38 weeks of gestation, while 52.2% (24/46) were in the third trimester. Among 46 cases, 87% (40/46) were left CDH, and 13% (6/40) were right CDH. The content of the hernia consisted of: intestines 93.5% (43/46); stomach 71.7% (30/46); liver 21.7% (10/46); omentum 13.0% (6/46); and colon 2.2% (1/46). The Lung Head Ratio (LHR) was 1.92 (0.76 – 4.79); 73.9% (34/46) had a LHR ≥1.4. Nine cases (19.6%) were associated with other anomalies: cardiac; nervous; digestive, musculoskeletal etc. Only nine cases (19.6%) underwent amniocentesis, and three cases were diagnosed with a genetic disorder. All cases received multidisciplinary counselling, including from a geneticist, an obstetrician, and a pediatric surgeon. Average Apgar scores at 1 minute and 5 minutes were 6 and 7, respectively. Among the 41 confirmed cases of CDH postnatal, nine patients died preoperatively (21.9%), while two cases were premature. 32 (79.1%) neonates underwent surgical repair, either via laparoscopic or laparotomy, in cases where two were premature and 30 were full-term. The surgical survival rate was 71.8% (23/32) and the surgical survival rate in full-term neonates was 76.7%. Prenatal diagnosis of CDH could play a key role in improving postnatal outcomes.