Table 1

Updated and new recommendations regarding prenatal diagnosis and management of CDH7–10 13 16 18 20 26 32 152–154

Updated recommendationsStrength of consensusLevel of evidence
1.1 Ultrasound measurement of o/e LHR using the trace method should be obtained between 22 and 32 weeks’ GA, in consultation with a regional fetal medicine/therapy programme.4B-NR
1.2 Observed/expected LHR cut-offs of <25% and <50% should be used to predict poor outcome for left and right CDH, respectively.4B-NR
1.3 MRI for the assessment of o/e TFLV and liver herniation should be considered in all fetuses with CDH, and is strongly recommended in fetuses with severe or moderate CDH by o/e LHR, ideally in collaboration with a fetal therapy programme.4B-NR
New recommendationsStrength of consensusLevel of evidence
1.4 Due to the increased risk of associated structural anomalies, a detailed anatomy assessment and a fetal echocardiogram should be performed in a tertiary fetal medicine centre for all pregnancies with prenatally diagnosed CDH.3B-NR
1.5 Invasive antenatal genetic testing, ideally with chromosomal microarray analysis, should be offered in all CDH pregnancies.4B-NR
1.6 Delivery at ~39 weeks gestation should be considered, with delivery planning in a tertiary centre experienced in the management of CDH with NICU, PICU and paediatric surgery expertise. Mode of delivery should be determined based on standard obstetric indications.4B-NR
  • CDH, congenital diaphragmatic hernia; GA, gestational age; NICU, neonatal intensive care unit; NR, non-randomised; o/e LHR, observed‐to‐expected lung‐to‐head ratio; o/e TFLV, observed‐to‐expected total fetal lung volume; PICU, paediatric intensive care unit.