Link: https://www.ncbi.nlm.nih.gov/pubmed/30511776

Prenat Diagn. 2018 Dec 4. doi: 10.1002/pd.5401. [Epub ahead of print]
Longitudinal changes in lung size and intrapulmonary artery Doppler during the second half of pregnancy in fetuses with congenital diaphragmatic hernia.
Cruz-Martinez R1, Martínez-Rodríguez M1, Nieto-Castro B1, Gámez-Varela A1, Cruz-Lemini M1, Luna-García J1, Juárez-Martínez I1.
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Abstract
OBJECTIVE:
To evaluate longitudinal changes in lung size and intrapulmonary artery (IPa) Doppler in fetuses with congenital diaphragmatic hernia (CDH) and assess their contribution in predicting neonatal survival.

METHODS:
The observed/expected lung-to-head ratio (O/E-LHR) and IPa-Pulsatility Index (PI) and Peak Early Diastolic Reversed Flow (PEDRF) were evaluated in a cohort of left-sided CDH fetuses managed expectantly during pregnancy. Longitudinal changes were analyzed by multilevel analysis, and their value to predict survival using multiple logistic regression and decision-tree analysis was assessed.

RESULTS:
A total of 232 scans were performed on 69 CDH fetuses. The O/E-LHR values remained unchanged during fetal monitoring, whereas IPa-PI and PEDRF showed a progressive increase throughout follow-up, becoming abnormal on average at 30 weeks of gestation. Absent/reversed end-diastolic velocity (EDV) in the IPa was observed in 20.3%. O/E-LHR and IPa Doppler indices were significantly associated with probability of survival (O/E-LHR ≥26%, odds ratio [OR] 19.0; IPa-PI <+2.0 Z-score, OR 3.0; and positive EDV, OR 7.4. All cases with IPa reversed EDV died after birth.

CONCLUSION:
While lung size remains stable during pregnancy, CDH fetuses show progressive deterioration in intrapulmonary blood flow. IPa Doppler evaluation may aid in predicting survival of CDH fetuses managed expectantly during pregnancy.

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PMID: 30511776 DOI: 10.1002/pd.5401