[size=20px]A 30-year-old G1P0 woman presents with a singleton pregnancy complicated by left-sided congenital diaphragmatic hernia (CDH). She is currently 29 weeksgestation. Fetal ultrasound demonstrated observed/expected lung-to-head ratio (O/E LHR) of 28%. No other structural abnormalities were identified on fetal ultrasound. Fetal MRI is not available. Karyotype was normal. Current recommendations for this patient include:

 

A Transfer to a center for fetoscopicendoluminal tracheal occlusion (FETO)

 

B Selective use of fetal echocardiogram

 

C Delivery at a center with protocolized management and ECMO capabilities

 

D Transfer to a center with fetal MRI​[/size]

A

C

correct answer

C Delivery at a center with protocolized management and ECMO capabilities

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This patient has moderate fetal CDH given the O/E LHR of 28%. In these patients, expectant mothers with mild to moderate CDH should undergo delivery at a center with protocolized management and ECMO capabilities.​

 

​Prenatal ultrasound measurements utilizing the trace method are adequate to assess O/E LHR and rule out other anomalies. Fetal MRI is not required if not readily available. FETO should be reserved for patients with severe CDH. A fetal echocardiogram should be obtained in all patients to characterize the degree of left ventricular hypoplasia and rule out cardiac defects.​

 

 

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