(714) Timing of delivery in pregnancies complicated by congenital diaphragmatic hernia

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: No specific recommendations for timing of delivery exist for pregnancies with fetal congenital diaphragmatic hernia (CDH). We hypothesize that delivery at full term, as compared to early term, results in improved fetal outcomes and increased opportunity for CDH repair.

Study Design: This is a retrospective study of singleton liveborn infants between 1/1/2011 and 6/30/2021 at a single institution. Patients and their liveborn infants with isolated CDH delivered at ≥37 weeks gestation were included. Data was obtained from established quality assurance databases as well as electronic medical record review. Statistical analysis included χ2 and Fisher’s exact test for categorical variables and student’s t-test for continuous variables.

Results: 118,720 patients delivered at our institution of which 2,574 (2.2%) had major anomalies. 59 had singletons with CDH, 37 of which were isolated. CDH was the indication for delivery for 11 patients - four early term and seven term. Birthweight was lower in the early term vs. term patients (2840g vs. 3450g, p < .0001) but there were no differences in Apgar score, umbilical artery pH, intubation, or other neonatal outcomes. 16 (89%) early term vs 13 (68%) term patients underwent successful CDH repair (p = 0.232). 15 (83%) early term vs 12 (63%) term patients survived to hospital discharge (p=0.269), which included CDH repair in each case. One patient had a prenatal plan for comfort care after delivery and was delivered at term.

Conclusion: There were no differences in neonatal outcomes in patients who delivered term as compared to early term. There was a trend towards higher rates of CDH repair in early term neonates, which did not reach significance. Delivery at any gestational age ≥37 weeks gestation appears reasonable.

Primary & Presenting Author(s)

Elise A. Rosenthal, MD (she/her/hers)
Fellow
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Coauthor(s)

SG
Sameer Gajjar, MD
University of Texas Southwestern
Dallas, Texas, United States
KW
Kristen Warncke, MD
Parkland Health
Columbia, Missouri, United States
KH
Kaela Harvey, BA
University of Texas Southwestern
Dallas, Texas, United States
JH
June Hu, MD
University of Texas Southwestern
Dallas, Texas, United States
JP
Jessica E. Pruszynski, PhD
UT Southwestern Medical Center
Dallas, Texas, United States
JD
Jodi Dashe, MD
University of Texas Southwestern
Dallas, Texas, United States
Elaine L. Duryea, MD
Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States