weekly_question 16/10/2022

[Admin]

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

[Admin]

correct answer
C Delivery at a center with protocolized management and ECMO capabilities

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.

[Ismail]

A

[Ismail]

C

[Admin]

correct answer
C Delivery at a center with protocolized management and ECMO capabilities

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.