Fetal MRI pp 329-341 | Cite as

Diagnosis of Congenital Diaphragmatic Hernia

Part of the Medical Radiology book series (MEDRAD)


With advances in ultrasound technology, congenital diaphragmatic hernia (CDH) is easily diagnosed prenatally. In contrast, prenatal prognostication remains a challenge. In view of the current availability of fetal therapy this becomes even more important. To date, one of the most studied markers is the lung-area to head circumference ratio and has been shown in large studied to be predictive of postnatal outcome in terms of survival and also morbidity. Since the fetal lung is a fluid filled structure hence has high signal intensity on T2-WI, it can be easily discernible from the surrounding structures using fetal magnetic resonance imaging (MRI). This remains so even in case of oligohydramnios and obesity, conditions that make appropriate ultrasound evaluation difficult and inaccurate. The advantage of prenatal assessment in CDH using fetal MRI is that both lungs can be measured accurately, prediction can be adjusted to fetal biometry using the fetal body volume and intrathoracic position of the liver can be quantified, given a more accurate prediction of postnatal survival rather than the simple semiquantitative assessment of liver position. Further research using fetal MRI is directed towards the assessment of lungs at the microstructural level.


Apparent Diffusion Coefficient Congenital Diaphragmatic Hernia Congenital Diaphragmatic Hernia Pulmonary Hypoplasia Contralateral Lung 


  1. Ackerman KG, Herron BJ, Vargas SO, Huang H, Tevosian SG, Kochillas L, Rao C, Pober BR, Babiuk RP, Epstein JA, Greer JJ, Beier DR (2005) Fog2 is required for normal diaphragm and lung development in mice and humans. PLos Genet 1:58–65PubMedCrossRefGoogle Scholar
  2. Albanese CT, Lopoo J, Goldstein RB, Filly RA, Feldstein VA, Calen PW, Jennings RW, Farrell JA, Harrison MR (1998) Fetal liver position and prenatal outcome for congenital diaphragmatic hernia. Prenat Diagn 18:1138–1142PubMedCrossRefGoogle Scholar
  3. Bagolan P, Casaccia G, Crescenzi F, Nahom A, Trucchi A, Giorlandino C (2004) Impact of a current treatment protocol on outcome of high-risk congenital diaphragmatic hernia. J Pediatr Surg 39:313–318PubMedCrossRefGoogle Scholar
  4. Bahlmann F, Merz E, Hallermann C, Stopfkuchen H, Kramer W, Hofmann M (1999) Congenital diaphragmatic hernia: ultrasonic measurement of fetal lungs to predict pulmonary hypoplasia. Ultrasound Obstet Gynecol 14:162–168PubMedCrossRefGoogle Scholar
  5. Balassy C, Kasprian G, Brugger PC, Csapo B, Weber M, Hörmann M, Bankier A, Bammer R, Herold CJ, Prayer D (2008) Diffusion-weighted MR imaging of the normal fetal lung. Eur Radiol 18:700–706PubMedCrossRefGoogle Scholar
  6. Bootstaylor BS, Filly RA, Harrison MR, Adzick NS (1995) Prenatal sonographic predictors of liver herniation in congenital diaphragmatic hernia. J Ultrasound Med 914:515–520Google Scholar
  7. Brewerton LJ, Chari RS, Liang Y, Bhargava R (2005) Fetal lung-to-liver signal intensity ratio at MR imaging: development of a normal scale and possible role in predicting pulmonary hypoplasia in utero. Radiology 235:1005–1010PubMedCrossRefGoogle Scholar
  8. Butler N, Claireaux AE (1962) Congenital diaphragmatic hernia as a cause of perinatal mortality. Lancet 1:659–663PubMedCrossRefGoogle Scholar
  9. Cannie M, Jani JC, De Keyzer F, Devlieger R, Van Schoubroeck D, Witters I, Marchal G, Dymarkowski S, Deprest JA (2006) Fetal body volume: use at MR imaging to quantify relative lung volume in fetuses suspected of having pulmonary hypoplasia. Radiology 241:847–853PubMedCrossRefGoogle Scholar
  10. Cannie M, Jani J, Chaffiotte C, Vaast P, Deruelle P, Houfflin-Debarge V, Dymarkowski S, Deprest J (2008a) Quantification of intrathoracic liver herniation by magnetic resonance imaging and prediction of postnatal survival in fetuses with congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 32:627–632PubMedCrossRefGoogle Scholar
  11. Cannie M, Jani J, Meersschaert J, Allegaert K, Done’ E, Marchal G, Deprest J, Dymarkowski S (2008b) Prenatal prediction of survival in isolated diaphragmatic hernia with observed over expected total fetal lung volume determined by magnetic resonance imaging based either on gestational age or fetal body volume. Ultrasound Obstet Gynecol 32:633–639PubMedCrossRefGoogle Scholar
  12. Cannie M, Jani J, Van Kerkhove F, Meerschaert J, De Keyzer F, Lewi L, Deprest J, Dymarkowski S (2008c) Fetal body volume at MR imaging to quantify total fetal lung volume – normal ranges. Radiology 247:197–203PubMedCrossRefGoogle Scholar
  13. Coakley FV, Lopoo JB, Lu Y, Hricak H, Albanese CT, Harrison MR, Filly RA (2000) Normal and hypoplastic fetal lungs: volumetric assessment with prenatal single-shot rapid acquisition with relaxation enhancement MR imaging. Radiology 216:107–111PubMedGoogle Scholar
  14. Colvin J, Bower C, Dickinson J, Sokol J (2005) Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics 116:e356–e363PubMedCrossRefGoogle Scholar
  15. Cortes R, Keller R, Townsend T, Harrison MR, Farmer DL, Lee H, Piecuch RE, Leonard CH, Hetherton M, Bisgaard R, Nobuhara KK (2005) Survival of severe congenital diaphragmatic hernia has morbid consequences. J Pediatr Surg 40:36–45PubMedCrossRefGoogle Scholar
  16. Crane JP (1979) Familial congenital diaphragmatic hernia: prenatal diagnostic approach and analysis of twelve families. Clin Genet 16:244–252PubMedCrossRefGoogle Scholar
  17. Crankson SJ, Al Jadaan SA, Namshan MA, Al-Rabeeah AA, Oda O (2006) The immediate and long-term outcomes of newborns with congenital diaphragmatic hernia. Pediatr Surg Int 22:335–340PubMedCrossRefGoogle Scholar
  18. Davis PJ, Firmin RK, Manktelow B, Goldman AP, Davis CF, Smith JH, Cassidy JV, Shekerdemian LS (2004) Long-term outcome following extracorporeal membrane oxygenation for congenital diaphragmatic hernia: the UK experience. J Pediatr 144:309–315PubMedCrossRefGoogle Scholar
  19. Deprest J, Gratacos E, Nicolaides KH, on behalf of the FETO task group (2004) Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results. Ultrasound Obstet Gynecol 24:121–126Google Scholar
  20. Dommergues M, Louis-Sylvestre C, Mandelbrot L, Oury JF, Herlicoviez M, Body G, Gamerre M, Dumez Y (1996) Congenital diaphragmatic hernia: can prenatal ultrasonography predict outcome? Am J Obstet Gynecol 174:1377–1381PubMedCrossRefGoogle Scholar
  21. Downard C, Jaksic T, Garza J, Dzakovic A, Nemes L, Jennings RW, Wilson JM (2003) Analysis of an improved survival rate for congenital diaphragmatic hernia. J Pediatr Surg 38:729–732PubMedCrossRefGoogle Scholar
  22. Enns GM, Cox VA, Goldstein RB, Gibbs DL, Harrison MR, Golabi M (1998) Congenital diaphragmatic defects and associated syndromes, malformations and chromosomal anomalies. Am J Med Genet 79:215–225PubMedCrossRefGoogle Scholar
  23. Flake AW, Crombleholme TM, Johnson MP, Howell LJ, Adzick NS (2000) Treatment of severe congenital diaphragmatic hernia by fetal tracheal occlusion: clinical experience with fifteen cases. Am J Obstet Gynecol 183:1059–1066PubMedCrossRefGoogle Scholar
  24. Fuke S, Kanzaki T, Mu J, Wasada K, Takemura M, Mitsuda N, Murata Y (2003) Antenatal prediction of pulmonary hypoplasia by acceleration time/ejection time ratio of fetal pulmonary arteries by Doppler blood flow velocimetry. Am J Obstet Gynecol 188:228–233PubMedCrossRefGoogle Scholar
  25. Gallot D, Coste K, Francannet C, Laurichesse H, Boda C, Ughetto S, Vanlieferinghen P, Scheye T, Vendittelli F, Labbe A, Dechelotte PJ, Sapin V, Lemery D (2005) Antenatal detection and impact on outcome of congenital diaphragmatic hernia: a 12-year experience in Auvergne (France). Eur J Obstet Gynecol Reprod Biol 125:202–205PubMedCrossRefGoogle Scholar
  26. Gorincour G, Bouvenot J, Mourot MG, Sonigo P, Chaumoitre K, Garel C, Guibaud L, Rypens F, Avni F, Cassart M, Maugey-Laulom B, Bourliere-Najean B, Brunelle F, Durand C, Eurin D, Groupe Radiopediatrique de Recherche en Imagerie Foetale (GRRIF) (2005) Prenatal prognosis of congenital diaphragmatic hernia using magnetic resonance imaging measurement of fetal lung volume. Ultrasound Obstet Gynecol 26:738–744PubMedCrossRefGoogle Scholar
  27. Graham G, Devine PC (2005) Antenatal diagnosis of CDH. Semin Perinatol 29:69–76PubMedCrossRefGoogle Scholar
  28. Hara A, Chapin CJ, Ertsey R, Kitterman J (2005) Changes in fetal lung distension alter expression of vascular endothelial growth factor and its isoforms in the developing rat lung. Pediatr Res 58:30–37PubMedCrossRefGoogle Scholar
  29. Harrison M, Bjordal R, Langmark F, Knutrud O (1978) Congenital diaphragmatic hernia: the hidden mortality. J Pediatr Surg 13:227–230PubMedCrossRefGoogle Scholar
  30. Harrison MR, Mychaliska GB, Albanese CT, Jennings RW, Farrell JA, Hawgood S, Sandberg P, Levine AH, Lobo E, Filly RA (1998) Correction of congenital diaphragmatic hernia in utero IX. Fetuses with poor prognosis (liver herniation and low lung-to-head ratio) can be saved by fetoscopic temporary tracheal occlusion. J Pediatr Surg 33:1017–1023PubMedCrossRefGoogle Scholar
  31. Hatch EI, Kendall J, Blumhagen J (1992) Stomach position as an in utero predictor of neonatal outcome in left-sided diaphragmatic hernia. J Pediatr Surg 27:778–779PubMedCrossRefGoogle Scholar
  32. Hedrick HL, Danzer E, Merchant A, Bebbington MW, Zhao H, Flake AW, Johnson MP, Liechty KW, Howell LJ, Wilson RD, Adzick NS (2007) Liver position and lung-to-head ratio for prediction of extracorporeal membrane oxygenation and survival in isolated left congenital diaphragmatic hernia. Am J Obstet Gynecol 197(422):e1–e4Google Scholar
  33. Heling KS, Wauer RR, Hammer H, Bollmann R, Chaoui R (2005) Reliability of the lung-to-head ratio in predicting outcome and neonatal ventilation parameters in fetus with congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 25:112–118PubMedCrossRefGoogle Scholar
  34. Jaillard SM, Pierrat V, Dubois A, Truffert P, Lequien P, Wurtz AJ, Storme L (2003) Outcome at 2 years of infants with congenital diaphragmatic hernia: a population-based study. Ann Thorac Surg 75:250–256PubMedCrossRefGoogle Scholar
  35. Jani J, Gratacos E, Greenough A, Piero JL, Benachi A, Harrison M, Nicolaides K, Deprest J, FETO Task Group (2005) Percutaneous fetal endoscopic tracheal occlusion (FETO) for severe left sided congenital diaphragmatic hernia. Clin Obstet Gynecol N Am 48:910–922CrossRefGoogle Scholar
  36. Jani J, Keller RL, Benachi A, Nicolaides KH, Favre R, Gratacos E, Laudy J, Eisenberg V, Eggink A, Vaast P, Deprest J (2006a) Prenatal prediction of survival in isolated left-sided diaphragmatic hernia. Ultrasound Obstet Gynecol 27:18–22PubMedCrossRefGoogle Scholar
  37. Jani J, Peralta CFA, Van Schoubroeck D, Deprest J, Nicolaides KH (2006b) Relation between lung-to-head ratio and lung volume in normal fetuses and fetuses with diaphragmatic hernia. Ultrasound Obstet Gynecol 27:545–550PubMedCrossRefGoogle Scholar
  38. Jani J, Cannie M, Peralta CFA, Deprest J, Nicolaides KH, Dymarkowski S (2007a) Lung volumes in fetuses with congenital diaphragmatic hernia: comparison of 3D US and MR Imaging assessments. Radiology 244:575–582PubMedCrossRefGoogle Scholar
  39. Jani J, Nicolaides KH, Keller RL, Benachi A, Peralta CFA, Favre R, Moreno O, Tibboel D, Lipitz S, Eggink A, Vaast P, Allegaert K, Harrison M, Deprest J; on behalf of the antenatal-CDH-Registry group (2007b) Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet Gynecol 30:67–71Google Scholar
  40. Jani J, Peralta CFA, Ruano R, Benachi A, Done E, Nicolaides KH, Deprest J (2007c) Comparison of fetal lung area to head circumference ratio with lung volume in the prediction of postnatal outcome in diaphragmatic hernia. Ultrasound Obstet Gynecol 30:850–854PubMedCrossRefGoogle Scholar
  41. Jani J, Cannie M, Sonigo P, Robert Y, Moreno O, Benachi A, Vaast P, Gratacos E, Nicolaides K, Deprest J (2008b) Prenatal prediction of survival in diaphragmatic hernia by fetal lung volume measured by magnetic resonance imaging. Ultrasound Obstet Gynecol 32:793–799PubMedCrossRefGoogle Scholar
  42. Jani J, Benachi A, Nicolaides KH, Allegaert K, Gratacós E, Mazkereth R, Matis J, Tibboel D, van Heijst A, Storme L, Rousseau V, Greenough A, Deprest JA; and the antenatal-CDH-Registry group (2009) Prenatal prediction of neonatal morbidity in survivors with congenital diaphragmatic hernia: a multicenter study. Ultrasound Obstet Gynecol 33:64–69Google Scholar
  43. Kalache KD, Espinoza J, Chaiworapongsa T, Londono J, Schoen ML, Treadwell MC, Lee W, Romero R (2003) Three-dimensional ultrasound fetal lung volume measurement: a systematic study comparing the multiplanar method with the rotational (VOCAL) technique. Ultrasound Obstet Gynecol 21:111–118PubMedCrossRefGoogle Scholar
  44. Keijzer R, Liu J, Deimling J, Tibboel D, Post M (2000) Dual-hit hypothesis explains pulmonary hypoplasia in the nitrofen model of congenital diaphragmatic hernia. Am J Pathol 156:1299–1306PubMedCrossRefGoogle Scholar
  45. Keller TM, Rake A, Michel SC, Seifert B, Wisser J, Marincek B, Kubik-Huch RA (2004) MR assessment of fetal lung development using lung volumes and signal intensities. Eur Radiol 14:984–989PubMedCrossRefGoogle Scholar
  46. Kitano Y, Nakagawa S, Kuroda T, Honna T, Itoh Y, Nakamura T, Morikawa N, Shimizu N, Kashima K, Hayashi S, Sago H (2005) Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy. J Pediatr Surg 40:1827–1832PubMedCrossRefGoogle Scholar
  47. Laudy JA, Wladimiroff J (2000) The fetal lung 2: pulmonary hypoplasia. Ultrasound Obstet Gynecol 16:482–494PubMedCrossRefGoogle Scholar
  48. Laudy JAM, Van Gucht M, Van Dooren MF, Wladimiroff JW, Tibboel D (2003) Congenital diaphragmatic hernia. an evaluation of the prognostic value of the lung-to-head ratio and other prenatal parameters. Prenat Diag 23:634–639CrossRefGoogle Scholar
  49. Lipshutz GS, Albanese CT, Feldstein VA, Jennings RW, Housley HT, Beech R, Farrell JA, Harrison MR (1997) Prospective analysis of lung-to-head ratio predicts survival for patients with prenatally diagnosed congenital diaphragmatic hernia. J Pediatric Surg 32:1634–1636CrossRefGoogle Scholar
  50. Mahieu-Caputo D, Sonigo P, Dommergues M, Fournet JC, Thalabard JC, Abarca C, Benachi A, Brunelle F, Dumez Y (2001) Fetal lung volume measurement by magnetic resonance imaging in congenital diaphragmatic hernia. BJOG 108:863–868PubMedGoogle Scholar
  51. Mahieu-Caputo D, Aubry MC, El Sayed M, Joubin L, Thalabard JC, Dommergues M (2004) Evaluation of fetal pulmonary vasculature by power Doppler imaging in congenital diaphragmatic hernia. J Ultrasound Med 23:1011–1017PubMedGoogle Scholar
  52. Manganaro L, Perrone A, Sassi S, Fierro F, Savelli S, Di Maurizio M, Tomei A, Francioso A, La Barbera L, Giancotti A, Ballesio L (2008) Diffusion-weighted MR imaging and apparent diffusion coefficient of the normal fetal lung: preliminary experience. Prenat Diagn 28:745–748PubMedCrossRefGoogle Scholar
  53. Metkus AP, Filly RA, Stringer MD, Harrison MR, Adzick NS (1996) Sonographic predictors of survival in fetal diaphragmatic hernia. J Ped Surg 31:148–151CrossRefGoogle Scholar
  54. Moeglin D, Talmant C, Duyme M, Lopez AC, CFEF (2005) Fetal lung volumetry using two- and three-dimensional ultrasound. Ultrasound Obstet Gynecol 25:119–127PubMedCrossRefGoogle Scholar
  55. Moore RJ, Strachan B, Tyler DJ, Baker PN, Gowland PA (2001) In vivo diffusion measurements as an indication of fetal lung maturation using echo planar imaging at 0.5T. Magn Reson Med 45:247–253PubMedCrossRefGoogle Scholar
  56. Muratore C, Kharasch V, Lund D, Sheils C, Friedman S, Brown C, Utter S, Jaksic T, Wilson J (2001a) Pulmonary morbidity in 100 survivors of congenital diaphragmatic hernia monitored in a multidisciplinary clinic. J Pediatr Surg 36:133–140PubMedCrossRefGoogle Scholar
  57. Muratore C, Utter S, Jaksic T, Lund D, Wilson J (2001b) Nutritional morbidity in survivors of congenital diaphragmatic hernia. J Pediatr Surg 36:1171–1176PubMedCrossRefGoogle Scholar
  58. Norio R, Kaariainen H, Rapola J, Herva R, Kekomäki M (1984) Familial CDH defects: aspects of etiology, prenatal diagnosis and treatment. Am J Med Genet 17:471–483PubMedCrossRefGoogle Scholar
  59. Osada H, Kaku K, Masuda K, Iitsuka Y, Seki K, Sekiya S (2004) Quantitative and qualitative evaluations of fetal lung with MR imaging. Radiology 231:887–892PubMedCrossRefGoogle Scholar
  60. Paek BW, Coakley FV, Lu Y, Filly RA, Lopoo JB, Qayyum A, Harrison MR, Albanese CT (2001) Congenital diaphragmatic hernia: prenatal evaluation with MR lung volumetry-preliminary experience. Radiology 220:63–67PubMedGoogle Scholar
  61. Ruano R, Benachi A, Joubin L, Aubry MC, Thalabard JC, Dumez Y, Dommergues M (2004) Three-dimensional ultrasonographic assessment of fetal lung volume as prognostic factor in isolated congenital diaphragmatic hernia. BJOG 111:423–429PubMedCrossRefGoogle Scholar
  62. Rypens F, Metens T, Rocourt N, Sonigo P, Brunelle F, Quere MP, Guibaud L, Maugey-Laulom B, Durand C, Avni FE, Eurin D (2001) Fetal lung volume: estimation at MR imaging-initial results. Radiology 219:236–241PubMedGoogle Scholar
  63. Sbragia L, Paek B, Filly RA, Harrison MR, Farrell J, Farmer D, Albanese CT (2000) Congenital diaphragmatic hernia without herniation of the liver: does the lung-to-head ratio predict survival? J Ultrasound Med 19:845–848PubMedGoogle Scholar
  64. Scott L (2004) Ontario Congenital Anomalies Study Group. Apparent truth about congenital diaphragmatic hernia: a population-based database is needed to establish benchmarking for clinical outcomes for CDH. J Pediatr Surg 39:661–665CrossRefGoogle Scholar
  65. Sharland GK, Lockhart SM, Heward AJ, Allan LD (1992) Prognosis in fetal diaphragmatic hernia. Am J Obstet Gynecol 166:9–13PubMedGoogle Scholar
  66. Skari H, Bjornland K, Haugen G, Egeland T, Emblem R (2000) CDH: a meta-analysis of martoality factors. J Ped Surg 35:1187–1197CrossRefGoogle Scholar
  67. Slavotinek AM (2005) The genetics of congenital diaphragmatic hernia. Sem Perinatol 29:77–85CrossRefGoogle Scholar
  68. Sokol J, Bohn D, Lacro R, Ryan G, Stephens D, Rabinovitch M, Smallhorn J, Hornberger LK (2002) Fetal pulmonary artery diameters and their association with lung hypoplasia and postnatal outcome in congenital diaphragmatic hernia. Am J Obstet Gynecol 186:1085–1090PubMedCrossRefGoogle Scholar
  69. Stefanutti G, Filippone M, Tommasoni N, Midrio P, Zucchetta P, Moreolo GS, Toffolutti T, Baraldi E, Gamba P (2004) Cardiopulmonary anatomy and function in long-term survivors of mild to moderate congenital diaphragmatic hernia. J Pediatr Surg 39:526–531PubMedCrossRefGoogle Scholar
  70. Stege G, Fenton A, Jaffray B (2003) Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Pediatrics 12:532–535CrossRefGoogle Scholar
  71. Thebaud B, Azancot A, de Lagausie P, Vuillard E, Ferkadji L, Benali K, Beaufils F (1997) Congenital diaphragmatic hernia: antenatal prognostic factors. Does cardiac ventricular disproportion in utero predict outcome and pulmonary hypoplasia? Intensive Care Med 23:10062–10069PubMedGoogle Scholar
  72. Torfs CP, Curry CJ, Bateson TF, Honoré LH (1992) A population-based study of congenital diaphragmatic hernia. Teratology 46:555–565PubMedCrossRefGoogle Scholar
  73. Trachsel D, Selvadurai H, Bohn D, Langer JC, Coates AL (2005) Long-term pulmonary morbidity in survivors of congenital diaphragmatic hernia. Pediatr Pulmonol 39:433–439PubMedCrossRefGoogle Scholar
  74. Walsh DS, Hubbard AM, Olutoye OO, Howell LJ, Crombleholme TM, Flake AW, Johnson MP, Adzick NS (2000) Assessment of fetal lung volumes and liver herniation with magnetic imaging in congenital diaphragmatic hernia. Am J Obstet Gynecol 183:1067–1069PubMedCrossRefGoogle Scholar
  75. West S, Wilson J (2005) Follow up of infants with congenital diaphragmatic hernia. Semin Perinatol 29:129–133PubMedCrossRefGoogle Scholar
  76. Williams G, Coakley FV, Qayyum A, Farmer DL, Joe BN, Filly RA (2004) Fetal relative lung volume: quantification by using prenatal MR imaging lung volumetry. Radiology 233:457–462PubMedCrossRefGoogle Scholar
  77. Witters I, Legius E, Moerman P, Deprest J, Van Schoubroeck D, Timmerman D, Van Assche FA, Fryns JP (2001) Associated malformations and chromosomal anomalies in 42 cases of prenatally diagnosed diaphragmatic hernia. Am J Med Genet 103:278–282PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of RadiologyUniversity Hospital BrugmannBrusselsBelgium
  2. 2.Departments of Radiology, UZ BrusselsVrije Universiteit BrusselsBrusselsBelgium
  3. 3.Department of Obstetrics and Gynaecology, Section Fetal Medicine and TherapyUniversity Hospital BrugmannBrusselsBelgium

Personalised recommendations