Oscar Moreno

Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia.

To assess the value of antenatally determined observed to expected fetal lung area to head circumference ratio (LHR) in the prediction of postnatal survival in isolated, congenital diaphragmatic hernia (CDH).

Value of prenatal magnetic resonance imaging in the prediction of postnatal outcome in fetuses with diaphragmatic hernia

To investigate the potential value of antenatally determined total fetal lung volume (TFLV) by magnetic resonance imaging (MRI) in the prediction of the postnatal survival in congenital diaphragmatic hernia (CDH).

Timing of lung size assessment in the prediction of survival in fetuses with diaphragmatic hernia

To investigate whether the prediction of postnatal outcome of fetuses with isolated congenital diaphragmatic hernia depends on the gestational age at assessment using the fetal observed to expected (O/E) lung area to head circumference ratio (LHR), by comparing the performance of the test at 22–23 weeks with that at 32–33 weeks of gestation.

Prenatal Anatomical Imaging in Fetuses with Congenital Diaphragmatic Hernia

The role of prenatal ultrasound and magnetic resonance imaging in the diagnosis and management of congenital diaphragmatic hernia (CDH) is reviewed. Topics include morphologic imaging and vascular assessment of the developing lung, the value of imaging parameters as prognostic predictors in CDH and the role of imaging following percutaneous fetoscopic endoluminal tracheal occlusion.

OC15.01: Neonatal morbidity in fetuses with severe isolated CDH in the FETO era

Objectives: Chemotherapy damages ovarian reserve and induces premature ovarian failure. It has been shown that menstrual status, and cycle day 2 (CD2) FSH and estradiol (E2) levels are not reliable for the assessment of chemotherapy effects on fertility. The purpose of this study was to determine whether antral follicle count (AFC) is predictive for ovarian stimulation outcomes in pre(COH) and postchemotherapy (PCCOH) patients undergoing fertility preservation with oocyte or embryo freezing. Methods: This was a prospective study of 69 COH and 16 PCCOH women who underwent controlled ovarian hyperstimulation while AFC, anti-mullerian hormone (AMH), FSH and E2 were obtained on CD2. The predominant diagnosis was breast cancer (n = 74, 62 COH vs. 12 PCCOH). PCCOH patients received a variety of alkylating agents. Results: Total (14.4 ± 1.3 vs. 8.0 ± 1.1) and mature (9.7 ± 0.8 vs. 5.9 ± 0.9) oocytes retrieved and two pronuclear (2PN) embryos generated (7.7 ± 0.7 vs. 5.1 ± 0.8) were significantly higher for COH vs. PCCOH patients (P < 0.05). The mean age at time of stimulation, CD2-FSH, and E2 were not significantly different. AFC (13.1 ± 1.3 vs. 8.7 ± 1.2) and AMH (2.6 ± 0.4 vs. 1.1 ± 0.5) were significantly higher in the COH group (P < 0.05). Linear regression analysis for COH but not PCCOH patients demonstrated a significant positive correlation for AFC and AMH in predicting the number of total oocytes, mature oocytes and 2PN embryos (P < 0.05). Multivariate regression analysis using AFC and AMH improved prediction of these patient outcomes (R2 = 0.53). Conclusions: The results of this study demonstrated that after chemotherapy, CD2-FSH and E2 were unaltered but AMH, AFC and stimulation outcomes were significantly lower. The combined use of AFC and AMH showed a strong correlation for predicting stimulation outcomes in COH patients but further investigation is needed for PCCOH patients. Fertility preservation consultation, as well as AFC and AMH, for patients prior to chemotherapy may improve prediction of patient outcome.

OC272:Prenatal prediction of survival using lung volume at magnetic resonance imaging and liver position in isolated diaphragmatic hernia: a multicenter study

Objectives: The fetal lung area to head circumference ratio and position of the liver are predictors of survival in isolated CDH. We aimed to investigate the value of the observed/expected LHR (o/e LHR) and position of the liver in the prediction of neonatal morbidity in survivors with congenital diaphragmatic hernia (CDH). Methods: Neonatal morbidity was recorded in 100 consecutive cases with prenatally diagnosed isolated CDH, who were expectantly managed in the prenatal period, were delivered after 30 weeks and survived until discharge from the hospital. Regression analysis was used to identify the significant predictors of morbidity, including prenatal and immediate neonatal findings. Results: The o/e LHR was the main significant predictor of the need for prosthetic patch repair, duration of assisted ventilation, need for supplemental oxygen at 28 days, and incidence of feeding problems. An additional independent prenatal predictor of the need for patch repair was the presence of fetal liver in the chest. Conclusions: In isolated CDH the prenatally assessed size of the contralateral lung is a significant predictor of the need for prosthetic patch repair, the functional consequences of impaired lung development and occurrence of feeding problems.

OP02.20: Pattern of lung growth through the latter half of pregnancy in fetuses with isolated diaphragmatic hernia and prenatal prediction of survival

case was Fryns Sd. with multiple malformations and died with one hour of life. In group B we have eight cases, four 45X (Turner Sd), one trisomy 18 (Edwards Sd), one trisomy 21 (Down Sd) and two without karyotype alteration. In this group, all the fetuses presented cardiac abnormalities, and just one survived after cardiac surgery. The association between cystic hygroma and hydrops resulting in fetuses with cardiac abnormalities was 100% against 33% in fetus without hydrops. Conclusion: A significant incidence of aneuploidy was noted (82%). Targeted ultrasonography and extensive counselling of parents is recommended. For patients with hydrops presented in the first trimester, the bad prognosis should be informed with a strong probability of cardiac abnormalities.

OC29: Proposed trials for in utero therapy for severe isolated left‐sided congenital diaphragmatic hernia

OC28 The predictive values of ultrasonographic measurement of the fetal cardiothoracic ratio in pregnancies affected by homozygous α0-thalassemia K. Y. Leung1, C. Liao2, C. M. Li2, S. Y. Ma2, M. H. Y. Tang3, C. P. Lee1, Y. H. Lam4, V. Chan5 1The University of Hong Kong, Queen Mary Hospital, China, 2The Maternal and Neonatal Hospital of Guangzhou, China, 3Tsan Yuk Hospital, Hong Kong, China, 4Hong Kong Prenatal Diagnostic Centre, China, 5The University of Hong Kong, China

OC14.02: Lung‐to‐head ratio and liver position to predict outcome in early diagnosed isolated left sided diaphragmatic hernia fetuses: a multicenter study

DIAGNOSED ISOLATED LEFT SIDED DIAPHRAGMATIC HERNIA FETUSES: A MULTICENTER STUDY JACQUES JANI, ALEXANDRA BENACHI, RENE FAVRE, ROBERTA KELLER, HILDE VANDECRUYS, JULIAN DELGADO, MICHAEL HARRISON, JACQUELINE MATIS, EDUARD GRATACOS, KYPROS NICOLAIDES, JAN DEPREST, University Hospital Gasthuisberg, Obstetrics and Gynecology, Leuven, Belgium, Hopital Necker-Enfants Malades, Obstetrics and Gynaecology, Paris, France, CHRU Strasbourg, Obstetrics and Gynecology, Schiltigheim, France, University of California, San Francisco, Neonatology/Pediatrics, San Francisco, California, King’s College London, Harris Birthright Research Centre, London, United Kingdom, Hospital Universitari Vall Hebron, Obstetrics and Gynecology, Barcelona, Spain, University of California, San Francisco, Surgery & Pediatrics, San Francisco, California, CHRU Strasbourg, Neonatology, Schiltigheim, France OBJECTIVE: Congenital diaphragmatic hernia (CDH) is associated to high neonatal mortality. Accurate prediction of outcome is crucial in counselling parents about management options. We evaluated Lung-to-Head Ratio (LHR) and liver position in prediction of outcome of isolated Left CDH. STUDY DESIGN: Retrospective review of consecutive patients diagnosed with isolated LCDH %28 weeks, evaluated at 6 tertiairy units from 1995 onwards. Only patients with LHR measurements by experienced sonographers and with known liver position by ultrasound or MRI, both %28 wks, were included. Outcome measure was survival at discharge from NICU. RESULTS: 134 cases had an LHR obtained at 24.4 G 2.8 wks. 11 patients (8%) opted for termination after evaluation, all with LHR !1.4. There were no postnatal diagnoses of chromosomal anomalies. Overall survival was 43% (58/ 134), after substraction of antenatal losses 47% (58/123). In case of liver herniation survival was 35 %. LHR correlated to survival irrespective of liver position but combination of both variables predicted neonatal outcome better: liver up & LHR !1 predicted a survival of 9%. When LHR !0.8 and liver up, there were no survivors, but with liver down (37% of cases) survival was 40%. When LHR !0.6 there were no survivors irrespective of liver position. CONCLUSION: Combination of liver up& LHR !1 at %28 wks predicts a !10 % chance of survival, dropping to 0% if LHR !0.8. 8% of patients opted for termination after second opinion, all with LHR !1.4, but only in half this coincided with the above poor prognostic indicators.