Document Detail

Value of liver herniation in prediction of outcome in fetal congenital diaphragmatic hernia: a systematic review and meta-analysis.
MedLine Citation:
PMID:  20178116     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Intrathoracic liver herniation (ILH) is being used to estimate prognosis and hence guide antenatal interventions in fetal congenital diaphragmatic hernia (CDH). However, the literature regarding its utility in this role is conflicting. This review systematically examines the currently available evidence of ILH use in fetal CDH.
METHODS: MEDLINE and EMBASE databases were searched for the terms ((congenital diaphragmatic hernia) OR CDH) AND liver. Inclusion criteria were human case series of fetuses diagnosed with CDH using either ultrasound or magnetic resonance imaging. Included studies were required to have reported the antenatal liver position and the outcome (survival or not). Case reports, reviews and eventration series were excluded. Studies reporting similar cases from the same center over an overlapping time period were considered duplicates; only the larger of the studies were therefore included. Absolute totals were extracted and sums calculated. Fisher's exact test (FET) was used to compare survival rates in different groups.
RESULTS: The original search retrieved 338 studies. Applying inclusion/exclusion criteria and removing duplicates left 21 case series in 20 studies. Retrieved studies differed in the definitions of liver herniation, survival and treatment modality. In total, there were 407 fetuses in the liver-up (herniated) and 303 in the liver-down (not herniated) groups. Survival rates were 45.4% and 73.9%, respectively. The difference was statistically significant (FET = 56.4, P < 0.005). Sensitivity analysis for cases that had only conventional postnatal treatment was still significant (FET = 52.8, P < 0.005).
CONCLUSIONS: Liver herniation is associated with poorer prognosis in fetal CDH. Grading liver herniation or using it as part of a panel of markers may enhance the value of liver herniation as a prognostic test in fetal CDH.
D Mullassery; M E Ba'ath; E C Jesudason; P D Losty
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  35     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-05     Completed Date:  2010-10-19     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  609-14     Citation Subset:  IM    
Copyright Information:
Copyright 2010 ISUOG. Published by John Wiley & Sons, Ltd.
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MeSH Terms
Gestational Age
Hernia, Diaphragmatic / congenital,  diagnosis*,  mortality
Liver Diseases / congenital,  diagnosis*,  mortality
Prenatal Diagnosis / methods
Grant Support
G0802057//Medical Research Council
Comment In:
Ultrasound Obstet Gynecol. 2010 Aug;36(2):259   [PMID:  20632381 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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