Ultrasound in Obstetrics & Gynecology vol:36 issue:4 pages:452-475
OBJECTIVES: Left ventricular cardiac output is decreased in fetuses with congenital diaphragmatic hernia (CDH). Our aim was to assess whether this alters cerebral perfusion or growth in utero. METHODS: Fetal head circumference, biparietal diameter, lung-to-head ratio and middle cerebral artery (MCA) Doppler flow patterns were assessed with ultrasound in 103 fetuses with prenatally diagnosed CDH. Total fetal lung volume and cerebral volume were measured using magnetic resonance imaging. Values were transformed to gestational age independent scores (multiples of the median; MoM) and compared with controls. Subanalyses were made according to whether the CDH was left (n = 86) or right sided (n = 17) and to whether it was isolated (n= 86) or associated with other anomalies (n = 17). RESULTS: Middle cerebral artery flow velocity was significantly lower in CDH than in healthy fetuses (0.79 +/- 0.19 MoM; p < 0.0001) but MCA pulsatility index was unchanged (0.99 +/- 0.25 MoM; p = 0.79). Cranial biometry and cerebral volume in CDH fetuses fall in the normal range. Gestational age adjusted lung area was correlated with MCA peak systolic velocity which was in turn correlated with brain volume. CONCLUSIONS: Fetal cerebral blood flow velocities are decreased in CDH yet cranial and cerebral growth are conserved. Further work will need to address whether part of the neurologic impairment observed in long-term survivors of CDH finds its origin in the prenatal period. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.