Three-dimensional ultrasonographic assessment of fetal lung volume as prognostic factor in isolated congenital diaphragmatic hernia

Rodrigo Ruano, Alexandra Benachi, Laurence Joubin, Marie Cécile Aubry, Jean Christophe Thalabard, Yves Dumez, Marc Dommergues

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Abstract

Objective: To evaluate the potential of three-dimensional ultrasound to predict outcome in congenital diaphragmatic hernia. Design: Prospective observational study. Setting: Tertiary care centre. Population: Twelve cases of isolated congenital diaphragmatic hernia (11 left-sided, 1 right-sided) and 109 controls. Methods: Fetal lung volume was assessed by three-dimensional ultrasound using the technique of rotation of the multiplanar imaging. In the control fetuses, a logistic transformation was performed to correlate fetal lung volume with gestational age, and the confidence interval was obtained with a bootstrap resampling. A mathematical equation was then obtained allowing calculation of the expected fetal lung volume as a function of gestational age. In fetuses with congenital diaphragmatic hernia, the observed/expected lung volume ratio was compared with postnatal outcome. Main outcome measures: Neonatal mortality and pulmonary hypoplasia, which was defined as lung/body weight ratios less than 0.012. Results: The expected fetal lung volume was derived from the mathematical equation: Fetal lung volume (mL) = exp(4.72/(1 + exp((20.32 - gestational age in weeks) / 6.05))). The observed/expected fetal lung volume ratio was significantly lower in the congenital diaphragmatic hernia group (median: 0.34, range: 0.16-0.66), than in the control group (median: 1.02, range: 0.62-1.97, P < 0.0001). The distribution of this ratio was significantly downshifted in the infants with congenital diaphragmatic hernia who died (median: 0.19, range: 0.18-0.66) compared with survivors (median: 0.44, range: 0.36-0.66, P = 0.04). The observed/expected fetal lung volume ratio was also correlated with the postmortem lung/body weight ratio. Conclusion: In isolated congenital diaphragmatic hernia, fetal lung volume measurement by three-dimensional ultrasound is a potential predictor for pulmonary hypoplasia and postnatal outcome.

Original languageEnglish (US)
Pages (from-to)423-429
Number of pages7
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume111
Issue number5
DOIs
StatePublished - May 1 2004

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ASJC Scopus subject areas

  • Obstetrics and Gynecology

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