A five-year statewide experience with congenital diaphragmatic hernia

Article Abstract:

One reason for surgical correction of congenital diaphragmatic hernia (a malformation in which the contents of the abdomen have moved upward into the chest) prior to birth is the high mortality associated with surgery after delivery (up to 80 percent). However, prenatal treatment for this condition is also associated with high fetal mortality (75 percent, as determined from a total of eight cases). This approach carries risks for the mother, as well. To better assess the outcome and mortality associated with congenital diaphragmatic hernia, a statewide survey was carried out of all fetuses born with this complication in Iowa between 1983 and 1988. Out of 241,473 cases, 65 fetuses with congenital diaphragmatic hernia were born, an incidence of 1 in 3,715. When other severe abnormalities were involved, as was the case for 18 infants, the survival rate was 5.5 percent. Twenty-six of the remaining 47 infants survived. Comparisons among survivors and nonsurvivors from the group of infants without additional severe complications showed no differences in maternal age, gestational age at delivery, birth weight, type of hospital in which the delivery took place, or several other factors. A similar proportion of survivors and nonsurvivors were delivered by cesarean section. In 28 percent of the cases, the severe malformations could have been identified prenatally by chromosome analysis or ultrasound evaluation. The 55 percent survival rate of the remaining infants in this population-based study should be used as a standard for comparison with survival rates for prenatal surgical repair of congenital diaphragmatic hernia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Birth defects, Diaphragm, Diaphragmatic hernia

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Alpha-fetoprotein, free beta-human chorionic gonadotropin, and dimeric inhibin A produce the best results in a three-analyte, multiple-marker screening test for fetal Down syndrome

Article Abstract:

Maternal blood tests different than currently recommended to screen for fetal Down's syndrome may dramatically improve the accuracy of diagnosis and reduce false-positive results. Six markers found in maternal blood from 14 to 22 weeks gestation were identified in 45-50 mothers with normal pregnancies and 33 Down's syndrome pregnancies. Multiple-marker screening for alpha-fetoprotein, free beta-human chorionic gonadotropin, and dimeric inhibin A yielded a 97% detection of Down's syndrome cases with a false-positive rate of 16%. Current panels identify 60%, with 20%-25% false positives.

Methods, Diagnosis, Down syndrome, Inhibin, Chorionic gonadotropin, Chorionic gonadotropins, Prenatal diagnosis, Alpha fetoproteins

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