Correction of congenital diaphragmatic hernia in utero: VI. hard-earned lessons

Michael R. Harrison, N. Scott Adzick, Alan W. Flake, Russell W. Jennings, James M. Estes, Thomas E. MacGillivray, Jane T. Chueh, James D. Goldberg, Roy A. Filly, Ruth B. Goldstein, Mark A. Rosen, Charles Cauldwell, Anne H. Levine, Lori J. Howell

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219 Scopus citations

Abstract

Extensive experimental work suggests that repair of congenital diaphragmatic hernia (CDH) in utero may salvage severely affected fetuses who otherwise have a high expected mortality despite optimal postnatal care including extracorporeal membrane oxygenation (ECMO). We have reported that repair of CDH in utero is physiologically sound and safe for the mother, but technically difficult especially when the liver is herniated into the fetal chest. In the 3 years since our last report (1989 to 1991), 61 additional patients were referred for consideration of in utero repair. Fetal repair was attempted in 14 with severe isolated left CDH diagnosed before 24 weeks gestation. Five fetuses died intraoperatively, from technical problems related to reduction of incarcerated liver and uterine contractions-problems which have subsequently been surmounted. Nine patients were successfully repaired. Four babies survived, two delivered prematurely, and died, and three died in utero within 48 hours of repair. Intraoperative technical problems have been overcome; the factors limiting successful outcome are postoperative physiologic management of the matermal-fetal unit and effective tocolysis to control preterm labor.

Original languageEnglish (US)
Pages (from-to)1411-1418
Number of pages8
JournalJournal of Pediatric Surgery
Volume28
Issue number10
DOIs
StatePublished - 1993
Externally publishedYes

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Keywords

  • Congenital diaphragmatic hernia
  • fetal surgery
  • prenatal diagnosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Harrison, M. R., Adzick, N. S., Flake, A. W., Jennings, R. W., Estes, J. M., MacGillivray, T. E., Chueh, J. T., Goldberg, J. D., Filly, R. A., Goldstein, R. B., Rosen, M. A., Cauldwell, C., Levine, A. H., & Howell, L. J. (1993). Correction of congenital diaphragmatic hernia in utero: VI. hard-earned lessons. Journal of Pediatric Surgery, 28(10), 1411-1418. https://doi.org/10.1016/S0022-3468(05)80338-0