Late recurrence of a congenital diaphragmatic hernia. Case report

Article Abstract:

The case report is presented of a woman who developed vomiting during her 24th week of pregnancy and continued to experience pain after eating and occasional vomiting throughout the remainder of pregnancy. The symptoms worsened after delivery, and the patient lost weight until she weighed considerably less than before pregnancy. Examination showed that a congenital diaphragmatic hernia (in which the abdominal organs have moved into the chest cavity), which had been repaired at birth, had recurred. A description is presented of the anatomical findings observed when the newly recurred hernia was repaired. Much of the stomach was now located in the chest, having moved there through an eight-centimeter-long defect in the previously repaired diaphragm. Adhesions (fibrous tissue) complicated the hernia repair procedure. After surgery, the patient made a good recovery, and suffered no further symptoms. Vomiting in pregnancy that occurs later than the 12th week is often a sign of disease. Most diaphragmatic hernias in pregnancy are hiatal (when the stomach moves into the chest through the diaphragmatic opening that is normally occupied by the esophagus). These hernias are rarely congenital, as in the case described. Congenital hernias are structurally different from hiatal hernias. When hernias occur late in pregnancy, they are associated with high mortality for both mother and fetus. Vaginal delivery should not take place, and hernia repair is optimally performed at cesarean section. Surgical approaches are briefly discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Fetal diaphragmatic hernia, the value of fetal echocardiography in the prediction of postnatal outcome

Article Abstract:

When abnormalities in fetal development are diagnosed early, and the prognosis of such defects is known, appropriate pregnancy management can be arranged. Approximately one in 5000 pregnancies results in congenital diaphragmatic hernia (CDH), an inherited defect where the prognosis improves with early diagnosis. Survival rates for infants with CDH of 82 percent have been reported after surgical repair. Pulmonary hypoplasia, the underdevelopment of fetal lung tissue, which is difficult to measure, is the usual cause of death. Assessment of factors influencing prognosis of fetal CDH was made with echocardiography, the use of sound waves to graphically measure position and motion of the heart muscle. Congenital heart disease was diagnosed in three (16 percent) of the 19 CHD complicated pregnancies. Polyhydramnios, an increased amount of amniotic fluid surrounding the fetus, was found in 33 percent of the CDH fetuses, but did not indicate a poor prognosis. The location of the fetal stomach in the abdominal region of the body had a 100 percent survival rate while stomachs found in the thorax had a 50 percent survival rate. More favorable outcomes were found with smaller hernias. Detection of cardiac ventricular disproportion had poor prognosis; herniated organs applying pressure on the heart may have been responsible for this defect. Fetal echocardiography can be used to detect factors influencing fetal outcome in pregnancies complicated by CDH.

Research, Diagnosis, Genetic disorders, Echocardiography, Diagnostic imaging

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Warfarin-induced fetal diaphragmatic hernia: case report

Article Abstract:

Warfarin and heparin are agents used to stop blood from coagulating. The use of warfarin during early pregnancy has been known to cause fetal abnormalities. A 20-year-old woman in her seventh month of pregnancy developed a blood clot in a deep vein (deep vein thrombosis). She was treated with heparin during the remainder of the pregnancy and warfarin after delivery. The patient was told to continue the warfarin for one year after the delivery at which time pregnancy should be avoided. The patient became pregnant again during the time she was still taking warfarin. The patient stopped taking the warfarin in the 14th week of pregnancy and did not seek medical care until labor. Despite an uncomplicated delivery, the infant did not breathe at birth. Autopsy revealed multiple abnormalities, including incomplete formation of the diaphragm muscle and underdevelopment of both lungs. This case study is further confirmation that warfarin can cause birth defects. In cases where anticoagulation therapy is warranted early in pregnancy, heparin should be the drug of choice, as unlike warfarin, it does not cross the placenta, and therefore is unlikely to affect the fetus. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Abnormalities, Complications and side effects, Fetus, Drug therapy, Anticoagulants (Medicine), Anticoagulants, Thrombophlebitis, Heparin, Warfarin, Hernia

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