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- W2978378045 abstract "To develop a new method for assessing the degree of liver herniation in fetuses with congenital diaphragmatic hernia (CDH) by ultrasound imaging. A preliminary explorative study was conducted as retrospective review of medical records and ultrasound (US) images in 28 cases of isolated fetal CDH with liver herniation and known outcome. Areas of lungs and herniated liver were measured at the standard level of four-chamber view by manual tracing during live scan or off-line. The liver-to-lung area ratio was calculated dividing the area of liver by the lung(s) area. Comparison of data in groups according to neonatal outcome was done by t-test. There were 26 fetuses with left-sided and 2 with right-sided CDH. In 96.4% cases only contralateral lung was visualised at the four-chamber view. Mean gestational age at US evaluation was 32.5±6.2 weeks (range 20 - 38). Liver-to-lung area ratio varied from 0.43 to 5.28. In study group 35.7% (n=10) neonates were operated and survived, 64.3% died (n=18). Among neonates who died 33.3% (n=6) were operated and 66.7% (n=12) were not. The liver-to-lung area ratio in survivors group was 0.798±0.325 (range 0.432-1.326), in nonsurvivors - 2.153±0.931 (range 1.176-5.276), difference was statistically significant (p < 0.001). After assessment using ROC curve the optimal cut-off value obtained was 1.2 (sensitivity 94.4%, specificity 90.0%, accuracy 92.9%). For convenience of clinical implementation, we developed a working classification of liver herniation grades: a) ratio < 1.0 – mild (100% survival in our study population); b) 1.0-1.5 – significant (survival rate 50%), c) > 1.5 – severe (survival rate 0%). Liver-to-lung area ratio can be a new tool for US assessment of the degree of liver herniation into the chest in fetuses with CDH. It can be used in complex with other US prognostic markers to predict neonatal outcome and to plan management of pregnancy, delivery and specialised help to neonate. Further studies will be needed for external validation and cut-offs calibration for different clinical settings. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article." @default.
- W2978378045 created "2019-10-10" @default.
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- W2978378045 date "2019-09-30" @default.
- W2978378045 modified "2023-10-16" @default.
- W2978378045 title "OP20.09: Assessment of liver herniation by ultrasound imaging in fetuses with congenital diaphragmatic hernia" @default.
- W2978378045 doi "https://doi.org/10.1002/uog.20873" @default.
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