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Objective: To evaluate fetal brain development using MRI (magnetic resonance imaging) in CDH (congenital diaphragmatic hernia)., Methods: 52 isolated left CDH and 104 control fetuses were imaged using MRI. Brain morphometry (Biparietal diameter-BPD, brain fronto-occipital diameter-BFOD, third ventricle, posterior ventricles, transcerebellar diameter-TCD, anteroposterior and craniocaudal cerebellar vermis diameter-AP and CC) and cortical structures (bilateral cingulate fissure-CF, insular fissure-IF, insular depth - ID) were compared with controls using Mann-Whitney test., Results: Median gestational age at MRI (p = 0.95)and the median biparietal diameter (p = 0.737) were comparable. Among morphometric parameters, only the brain fronto-occipital diameter was significantly smaller in CDH (p = 0.001) and the third ventricle was significantly greater in CDH (<0.0001). Among cortical structures, the cingulate and insular fissures were significantly deeper in CDH fetuses (p < 0.0001) as the insular depth ID was smaller in CDH (p < 0.03)., Conclusions: CDH fetuses have a smaller fronto-occipital diameter, reduced insular depth, deeper cingulate and insular fissure, and greater third ventricle width as compared to controls. These findings suggest that left CDH may have an impact on fetal brain development with an overall reduction in brain volume., (© 2023 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.)

Objective: To quantify the mediastinal shift angle (MSA) in fetuses with isolated left congenital diaphragmatic hernia (CDH) by magnetic resonance imaging and evaluate survival., Method: Fetuses from singleton pregnancies with isolated left CDH were matched for gestational age with controls without thoracic malformations. For all fetuses the MSA was determined by two operators and inter-operator variability and differences between cases and controls were investigated. For all cases total fetal lung volume (TFLV) was calculated and the correlation between MSA and TFLV was assessed, and its predictive value towards survival was determined., Results: Thirty-four fetuses were included as cases and 42 as controls. The mean gestational age for assessment of CDH fetuses was 32 weeks (range 27-38). Twenty-four fetuses survived until discharge and 10 did not. There was an excellent inter-operator reliability for measuring the MSA and a significant difference between MSA in cases and controls. There was an inverse correlation between MSA values and survival, a correlation between TFLV and survival and an inverse correlation between MSA and TFLV. The area under the ROC curve for MSA in predicting survival was 0.931 (95% CI 0.851-1.000)., Conclusion: The MSA measured late in gestation correlates with postnatal survival in patients with isolated left CDH., (© 2019 John Wiley & Sons, Ltd.)

Background: The aim of our study was to evaluate the hemodynamic response to acute maternal hyperoxygenation (O2 test) in a group of growth retarded fetuses with absence or reversal of end-diastolic velocity (AREDV) in the umbilical artery (UA) and to correlate this response to a series of feto-placental velocimetric parameters and clinical variables., Methods: In 25 singleton pregnancies, feto-maternal Doppler velocimetry was performed before and after acute maternal hyperoxygenation., Results: Ten fetuses (40%) exhibited an increase of middle cerebral artery Pulsatility Index (PI) >20% after O2 (Responders), while in 15 fetuses PI did not change relevantly (Nonresponders). Non-responder fetuses showed a higher prevalence of reverse flow in umbilical artery (6/15 vs 0/10: p<0.03) and a slight, but not significant, higher percentage with reversed flow in inferior vena cava (% of A). Also the prevalence of a % of A greater than 95th confidence interval was higher in Non-responders (13/15 vs 4/10; p<0.04). Finally the Responder fetuses showed higher peak velocities in the cardiac outflows, even if the difference reached a statistical significance only for the pulmonary artery. The outcome of the two groups did not differ significantly., Conclusions: Our results seem to prove an ability of O2 test in selecting a group of AREDV fetuses characterized by a higher degree of hemodynamic deterioration and hence 'placed' in a more advanced step of the pathological process leading to overt cardiac decompensation, even if the clinical application of such a test seems to be still of limited value.