| Objective Fetal congenital diaphragmatic hernia is a common type of fetal thoracic malformations,and left diaphragmatic hernia is more common than right.Early and correct diagnosis and evaluation have important guiding significance for timely termination of pregnancy,ensuring maternal and child health,good birth and good breeding,and reducing medical risks.The ultrasonographic manifestations of the left congenital diaphragmatic hernia of the fetus are complicated and the prognosis of the fetus is quite different.This study focused on the diagnostic value of prenatal ultrasound in left congenital diaphragmatic hernia.Methods A total of 70 cases of fetal left CDH diagnosed by prenatal ultrasound were selected in our hospital from August 2016 to August 2019,all of these cases were single and confirmed by pathological anatomy after induction of labor,postnatal X-ray,surgery or MRI.The whole fetal system,placenta,amniotic fluid and umbilical cord were screened comprehensively,the biological parameters of the fetus were measured routinely,and the characteristics of gry-scale sonogram and color doppler flow imaging(CDFI)were summarized.we used the method of lung contour tracing to measure the contralateral lung area on the transverse images of chest cavity at apical four-chamber heart level at 24 to 26 weeks of gestation.Divide the lung area by the head circumference to calculate the lung-to-head ratio(LHR)of the contralateral lung,and compare this with the normal lung fetal LHR(expected LHR)of the same gestational week to obtain the ratio(observed/expected LHR,O/E LHR).The differences in the prognosis of children with different LHR and O/E LHR were compared for the fetuses who were chosen to continue the pregnancy until born.The sick children were followed up for 6 months to acquire the surgical status and survival status of children after birth,and the mortality was counted.Results A total of 70 cases of fetal left CDH diagnosed in our hospital were collected,and their sonograms showed solid or cystic solid lesion in the thorax,mediastinal displacement,lung dysplasia,reduced abdominal circumference,defect of the diaphragmatic echo,pleural effusion,etc.Gastric vesicles were observed in 59 cases and 11 cases were still in the abdominal cavity.In 62 cases,the superior mesenteric artery was turned upward and entered the chest by CDFI.Of the 70 cases,38 were induced labor,26 were full-term pregnancy,6 were premature,24 cases survived after surgery,3 died after surgery,and 5 died without surgery.The total mortality rate was25%(8/32).Among children born after delivery,the mortality rate of children with LHR≤1.0 was 71.43%(5/7),and that of children with O/E LHR≤35% was 85.71%(6/7),which was significantly higher than that of children in other groups with statistically significant differences(P < 0.05).Conclusions The sonographic manifestations of the left CDH are complex,including solid or cystic solid lesion in the thorax,mediastinal displacement,lung dysplasia,reduced abdominal circumference,defect of the diaphragmatic echo,pleural effusion,etc.In the CDFI mode,the superior mesenteric artery is detected turning upwards to the chest cavity by slowing the blood flow speed scale and increasing the color gain,which is more conducive to the diagnosis of CDH,especially to the atypical diaphragmatic hernia in which the gastric vesicle is located under the diaphragm in early second trimester.Prenatal ultrasound can evaluate the development of fetal contralateral lung through two parameters,LHR,O/E LHR,and provide important reference value for the prognosis of CDH fetus. |
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