How Is CDH Diagnosed?

Diagnosis of CDH usually occurs in the second trimester, when a routine prenatal ultrasound shows that abdominal organs have moved into the chest area. When CDH is suspected, patients are often referred to a maternal-fetal specialist for further care and evaluation. Maternal-fetal medicine physicians affiliated with The Fetal Center at Children’s Memorial Hermann Hospital may recommend other tests, including fetal MRI and fetal echocardiogram to assess the severity of the condition. They may also recommend amniocentesis to identify possible chromosomal abnormalities.

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During pregnancy, maternal-fetal medicine specialists monitor mother and baby to ensure that the baby develops appropriately in the uterus. The Fetal Center team works closely with families to determine the best course of treatment before and after delivery. This includes affiliated pediatric surgeons and affiliated neonatologists, as well as genetic counselors. A dedicated nurse coordinator keeps mothers in contact with all of the appropriate physicians and specialists and coordinates all aspects of care. Families are educated on CDH as well as its treatment options and possible outcomes.

Will a Fetal Treatment Be Required?

Treatment for babies diagnosed with CDH has traditionally focused on care after delivery. Fetal treatment is not required for babies in utero diagnosed with the condition; however, for the most severe cases of CDH, The Fetal Center offers a fetal surgery procedure as a treatment option before birth.

In an ongoing effort to provide optimal care to patients, The Fetal Center and its affiliated physicians have been granted FDA and institutional approval to offer fetoscopic endoluminal tracheal occlusion (FETO) to treat babies diagnosed with severe CDH before birth through the Center’s participation in the Tracheal Occlusion To Accelerate Lung Growth (TOTAL) Trial. FETO intervention, a minimally invasive fetoscopic procedure performed during pregnancy, involves placing a balloon in the baby’s airway, causing a backup of fluid produced by the lungs. As the fluid builds, lung growth and development is promoted.

Fetal Endoluminal Tracheal Occlusion (FETO)

What Special Considerations Should Be Made for Delivery?

For patients with congenital diagrammatic hernia (CDH) the level of care provided at the time of delivery can be critical to patients’ long-term health. It is essential that delivery of CDH patients occurs in a hospital that is well prepared to handle the intensive care and surgery required for infants with the condition. Close proximity to pediatric surgical services and effective coordination among specialized teams is important to optimizing care for CDH babies.

The Women’s Center at Children’s Memorial Hermann Hospital, offering comprehensive labor and delivery care as well as gynecological services, is located within the same tower as the 118-bed Level IV neonatal intensive care unit. In addition to the pediatric surgical services accessible to patients 24/7 at the hospital, the multidisciplinary team of neonatal nurses, neonatologists, and transport specialists utilize state-of-the-art neonatal equipment to provide specialized care immediately after birth.

  • Type of delivery: The delivery plan should be carefully pre-arranged and discussed between the mother and her obstetrician. Either a vaginal delivery or a cesarean section may be optimal for babies with CDH.
  • Place of delivery: The baby should be delivered at a hospital that is well prepared to handle the immediate intensive care and eventual surgery required for infants with CDH. Children’s Memorial Hermann Hospital , located within the same tower as the Women’s center, is equipped with a Level IV neonatal intensive care unit with the capability to provide specialized care such as extracorporeal membrane oxygenation (ECMO) similar to a heart-lung bypass, special mechanical ventilation, and 24/7 pediatric surgical services.
  • Time of delivery: There is no reason to intentionally induce early delivery. Most babies will benefit from reaching full gestational maturity.
  • Specialized delivery: You will develop a specialized birth plan, tailored to you and your child, and our expert team will be ready to care for your child from the instant they are delivered. Our ECMO team is on standby for the birth of every CDH patient.

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