Suspected Congenital Diaphragmatic Hernia

[lwillia1]

I am 24 week pregnant and at my 20 week ultrasound the baby was breech and they were unable to get a good image of his heart based on how he was positioned so we scheduled another one at 24 weeks. This time around they were able to see the heart but noticed that the diaphragm was not smooth looking like it ought to be, but was shaped like a "3" instead of an arc (I hope that makes sense). I was told that this could be a sign of a congenital diaphragmatic hernia. I am being sent to a high risk pregnancy clinic for another evaluation that is scheduled for next week. My OB did not mention that I had excess amniotic fluid or that any of the organs were in the wrong place, but it has me very nervous. I've read that if the baby does have this they have an increased chance of other congenital defects. Is this true? They said I would have to deliver out of town because they do not have adequate surgeons to fix the problem after the baby is born. What is the success rate for the surgery after birth? Is there anything that can be done during pregnancy? If it turns out the baby does have this, does it affect the pregnancy at all? Are there any increased risks to the other? I know it depends on how severe the case is, but can this have lasting effects even if the surgery is successful? I don't have a copy of the specific image that the OB had, but does the description of it appearing as a "3" mean anything to you? Could it have been a shadow or something? This is my first baby and everything is new to me so this really has me stressed out.

[finallyamommy2003]

Wow Best of luck and praying that everything is ok for you and the little one.... I know how stressful pregnancy are!!! I'm 14 weeks prego

[Elaine Brown, MD]

Hi!
I certainly understand why you are upset.
It is so nerve wracking to get that kind of information and not be able to find out more about it immediately.
Your visit to your high risk specialist will be very important, and I would suggest that you copy all the questions that you have listed here to ask at that visit! Then, write down all the answers you are given to read later after the visit.

The answer to all of your questions is going to depend a lot on whether or not the baby does indeed have a diaphragmatic hernia, and if so, how severe it is.

What a diaphragmatic hernia is, is a hole in the diaphragm that allows the stomach/bowel contents to protrude up into the lung cavity (almost always on the left side).  If the hernia is small, and the lung can develop fairly normally, then the prognosis is good.  If the hernia is large, sometimes the lung can't develop well, and even the heart can be pushed over to the wrong side of the chest.  This can be more serious.
From what I can discover in the literature, it appears to me that UCSF is the foremost center for fetal surgery to correct a diaphragmatic hernia before birth. You may want to request a referral there if things look serious.

The most important next step will be to find out exactly what it is that you are dealing with, and that will happen at your level 3 ultrasound with your perinatologist.
Good luck!
Dr B