The factors influencing parents and clinicians in medical decision making for fetuses with congenital diaphragmatic hernia at a tertiary referral centre in Beijing: a five-year retrospective study

The emerging demands for the most up to guide parents and clinicians in medical decision making for fetuses with congenital diaphragmatic hernia has become an urgent issue. We aimed to analysis the proposal for prenatal assessment of the fetuses with congenital diaphragmatic hernia at a tertiary referral centre in Beijing. The type and frequency of malformations associated with fetuses with congenital diaphragmatic hernia and the factors associated with pregnancy outcome were evaluated. All prenatal congenital diaphragmatic hernia cases detected by ultrasound between July 2017 and December 2022 at the Beijing Obstetrics and Gynecology Hospital were included. The data were compared between the born group and unborn group. The characteristics of the anomalies associated with congenital diaphragmatic hernia cases and the observed-to-expected lung area to head circumference ratio in born group were analysed. The maternal age, gestational age at diagnosis, genetic testing, ultrasound information, and pregnancy outcome were statistically analysed using two independent-sample t-test and χ2 square test. Univariate analysis was performed on the characteristics of these two groups, followed by multivariate analysis . A total of 105 fetuses with congenital diaphragmatic hernia were retrospectively reviewed. Overall mortality rates of isolated and non-isolated congenital diaphragmatic hernia cases in the born group were 34.4% and 30.0%, respectively. Antenatal diagnosis rates of congenital heart disease and increased nuchal translucency thicknesses with congenital diaphragmatic hernia were significantly different between the two groups (7% vs. 29%, p < 0.05; 2% vs. 23%, p < 0.05). In the multivariate analysis, the risk factors independently associated with pregnancy termination were gestational age at diagnosis (odds ratio [OR] 0.887, 95% CI 0.802–0.981, p < 0.05) and congenital heart disease (OR 0.158, 95% CI 0.030–0.841, p < 0.05). We call for a more positive advice for parents of fetuses with isolated, non-critical and non-isolated congenital diaphragmatic hernia based on an increased survival rate. The likelihood of termination of pregnancy in congenital diaphragmatic hernia is increased by early detection and the combination of congenital heart disease.In the born group, critical congenital heart disease and increased nuchal translucency thicknesses seem to be associated with a higher risk of neonatal mortality.