Revue de médecine périnatale

, Volume 1, Issue 1, pp 7–15 | Cite as

Prise en charge prénatale des fœtus porteurs de hernie de coupole diaphragmatique

Pour le Centre de référence « Hernie de coupole diaphragmatique »
  • A. Benachi
  • J. Saada
  • J. Martinovic
  • J. Jani
  • M. Cannie
  • L. Storme
  • P. de Lagausie
Mise au Point / Up to Date
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Résumé

L’évaluation prénatale du pronostic postnatal des enfants porteurs de hernie de coupole diaphragmatique (HCD) s’est améliorée au cours des cinq dernières années. Bien que les facteurs pronostiques utilisés ne fassent pas l’unanimité, il semble important que toutes les équipes utilisent les mêmes mesures afin de pouvoir comparer et améliorer nos pratiques. L’évaluation du pronostic se fera à l’aide du lung over head ratio (LHR) entre les 22 et 28 SA ou le LHR observé/attendu (LHR o/a), quels que soit le terme (dont lamesure répond à des critères stricts), la position du foie et la mesure du volume pulmonaire à l’IRM. Ces facteurs permettent de définir un groupe de fœtus porteurs de HCD de mauvais pronostic. Lorsque le LHR est inférieur à 1 ou le LHR o/a inférieur à 25 % et le foie dans le thorax, les chances de survie en période néonatale sont de moins de 15 %. Pour ce groupe, un traitement in utero peut être proposé. Un ballonnet est placé, entre 26 et 28 SA, par voie endoscopique dans la trachée fœtale sous les cordes vocales. Ce ballonnet est retiré vers 34 SA. Les premiers résultats montrent que le taux de survie de ces enfants passe de moins de 15 à environ 50 % de survie. Cette technique ne semble pas entraîner une majoration de la morbidité, mais cela reste à évaluer.

Mots clés

Hernie de coupole diaphragmatique Fœtus Pronostic PLUG 

Prenatal management of foetal congenital diaphragmatic hernia

Abstract

Prenatal assessment of the postnatal prognosis of foetuses with congenital diaphragmatic hernia (CDH) has improved over the past five years. Although the accuracy of this outcome evaluation remains a matter for debate, it seems important that all teams in charge of such foetuses use the same prognostic factors so that we can compare and improve our practice. Assessment will be based on lung over head ratio (LHR) between 22 and 28 weeks or observed/expected LHR whatever the gestational age (this measurement being subject to very strict criteria), position of the liver and lung volume as measured by MRI. These factors enable the identification of foetuses with poor prognosis. When LHR < 1 or LHR o/e < 25% and the liver is in the thorax, survival is less than 15%. In utero, treatment could be offered to such foetuses. A balloon is placed in the trachea, under the vocal cords, by foetoscopy. The balloon is retrieved at 34 weeks. The primary results show the survival rate of this group of patients rises from 15 to around 50%. Morbidity does not seem to be increased, but this is yet to be established.

Keywords

Congenital diaphragmatic hernia Foetus Pronostic PLUG 

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Copyright information

© Springer 2009

Authors and Affiliations

  • A. Benachi
    • 1
  • J. Saada
    • 1
  • J. Martinovic
    • 1
  • J. Jani
    • 2
  • M. Cannie
    • 2
  • L. Storme
    • 3
  • P. de Lagausie
    • 4
  1. 1.Site de Parishôpital Necker-Enfants-Malades, AP-HP, université Paris-DescartesParisFrance
  2. 2.Centre hospitalier universitaire BrugmannBruxellesBelgique
  3. 3.Site de Lillehôpital Jeanne-de-Flandre, CHRU de LilleLille cedexFrance
  4. 4.Site de MarseilleCHU de MarseilleMarseilleFrance

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