Congenital Diaphragmatic Hernia in Pregnancy
A suspected congenital diaphragmatic hernia needs more than a routine report. It needs a structured fetal medicine assessment of the diaphragm, lungs, heart, liver position, associated anomalies and delivery planning — explained clearly to the family.
Doctor-led counselling after a complex fetal diagnosis
Congenital diaphragmatic hernia, often shortened as CDH, can be an emotionally heavy diagnosis for parents. At Mayflower Clinic, the scan is not treated as a one-line abnormality. Dr. Kunda Shahane evaluates the finding systematically and explains the next steps in a calm, structured, medically honest manner.
The aim is to understand whether the CDH appears isolated or associated with other findings, estimate likely severity as far as prenatal assessment allows, and coordinate the pregnancy with the obstetrician, neonatology team and paediatric surgical team.
What is congenital diaphragmatic hernia?
CDH is a developmental condition in which there is an opening in the diaphragm, the muscle that separates the chest from the abdomen.
The diaphragm has a gap
Because of the opening, abdominal organs such as stomach, bowel and sometimes liver may move upward into the fetal chest.
The lungs may have less room
When organs occupy part of the chest, lung growth may be restricted. This is why fetal lung assessment is important.
Planning matters before birth
CDH babies often need specialised neonatal care after delivery. Prenatal diagnosis helps plan place, timing and team for birth.
Important point for parents
A CDH diagnosis does not mean every baby has the same severity. The counselling depends on many details: which side is involved, whether liver has moved into the chest, how much lung tissue is seen, whether the heart is structurally normal, whether other anomalies are present, and whether genetic testing is reassuring.
What Dr. Kunda evaluates in suspected CDH
The scan is designed to answer practical questions that help counselling and pregnancy planning.
| Assessment area | What is checked | Why it matters |
|---|---|---|
| Side of CDH | Left-sided Right-sided Rare bilateral | The side helps describe the anatomy and guides severity assessment and neonatal planning. |
| Stomach and bowel position | Whether the stomach or bowel loops are seen in the fetal chest. | This is often one of the first clues on anomaly scan and helps confirm the diagnosis. |
| Liver position | Liver down Liver up / intrathoracic liver | Liver herniation is an important severity marker and influences counselling. |
| Heart position and cardiac anatomy | Mediastinal shift, heart position, four-chamber view, outflow tracts and rhythm. | CDH can shift the heart; a dedicated fetal echocardiography helps exclude structural heart disease. |
| Lung size | Visible lung area and, when appropriate, observed-to-expected lung-to-head ratio assessment. | Lung size helps estimate likely postnatal respiratory challenge, while remembering that no prenatal measurement is perfect. |
| Associated anomalies | Brain, spine, face, heart, kidneys, limbs, abdomen, cord and placenta are reviewed. | Isolated CDH and CDH with additional findings have different counselling pathways. |
| Amniotic fluid and growth | Fetal growth, liquor volume, stomach filling and signs of pregnancy complications. | Serial monitoring helps identify changes that may affect pregnancy follow-up and delivery planning. |
| Need for further testing | Genetic counselling, amniocentesis/microarray discussion, fetal MRI referral when indicated. | Additional tests can clarify diagnosis, associated risks and postnatal care planning. |
Why GE Voluson Signature Expert matters in CDH assessment
CDH evaluation needs clear visualisation of the fetal chest, diaphragm, stomach, liver, lungs and heart. At Mayflower Clinic, advanced imaging on the GE Voluson Signature Expert supports systematic review of fetal anatomy, Doppler, cardiac views and serial comparison.
The machine supports the scan, but the interpretation depends on fetal medicine expertise, correct planes, careful documentation and meaningful counselling.
What happens after CDH is suspected?
Families need a clear sequence, not scattered opinions. This is the usual pathway after a suspected CDH finding.
Confirm the diagnosis with targeted fetal medicine scan
The fetal chest, diaphragm, stomach, bowel, liver, lungs, heart and remaining anatomy are reviewed carefully.
Perform fetal echocardiography
The heart may be displaced due to the hernia. A dedicated fetal heart scan helps check whether the heart structure itself is normal.
Discuss genetic counselling and testing options
If CDH is associated with other findings or if parents want clearer information, genetic counselling and prenatal diagnostic testing may be discussed.
Plan serial monitoring
Follow-up scans may monitor fetal growth, amniotic fluid, lung assessment, Doppler and any change in findings.
Coordinate delivery planning
The pregnancy is usually planned with a centre that has neonatal intensive care and paediatric surgical support, because the newborn may need immediate specialised care.
Questions that guide prognosis discussion
Prenatal counselling is never based on one sentence. It is based on a complete picture.
Is the CDH isolated?
The first major question is whether CDH is the only finding or whether there are additional structural anomalies. A detailed anomaly scan and fetal echo help answer this.
How much lung is visible?
Lung-size assessment, including O/E LHR when suitable, helps estimate likely respiratory challenge after birth. It is useful for counselling but does not provide certainty.
Is the liver in the chest?
Liver herniation is a key observation in CDH counselling. It can influence severity estimation and neonatal planning.
Where should delivery happen?
The birth plan should include an obstetrician, neonatal intensive care team and paediatric surgeon so that the baby receives immediate coordinated care.
When to book a CDH second opinion scan
A specialist review is useful when a routine scan has raised concern about fetal chest, diaphragm, stomach or heart position.
After anomaly scan
If the 18–22 week scan suggests stomach or bowel in the fetal chest, abnormal heart position or a suspected diaphragmatic defect.
After an unclear report
If the scan report mentions mediastinal shift, small lung, abnormal stomach position or “rule out CDH” and the family needs clarity.
For delivery planning
If CDH is already diagnosed and the family needs severity assessment, counselling and coordination with neonatal and surgical teams.
What to bring for your appointment
Please bring all previous ultrasound reports, anomaly scan images if available, NIPT or screening reports, obstetric notes, blood test reports, and any referral letter from your obstetrician. This helps Dr. Kunda review the full pregnancy context.
Dr. Kunda Shahane’s note on CDH diagnosis
“When parents hear the word congenital diaphragmatic hernia, they are naturally frightened. My role is to first confirm the anatomy carefully, then explain the severity markers step by step — lungs, liver, heart, associated anomalies and delivery planning. A complex diagnosis becomes easier to face when the family has a clear, honest and coordinated plan.”
CDH pregnancy scan and counselling FAQs
Can congenital diaphragmatic hernia be detected before birth?
Yes. CDH is often suspected during the second-trimester anomaly scan when abdominal organs are seen in the chest, the heart is shifted, or the lung space appears reduced. A specialist fetal medicine scan helps confirm and classify the finding.
Is fetal echocardiography needed in CDH?
Yes, it is commonly advised. CDH may shift the heart because of chest pressure, and a dedicated fetal echo helps check whether the heart structure is otherwise normal.
Will I need amniocentesis?
Not every family chooses invasive testing, but genetic counselling is important. If CDH is associated with other findings or if parents want chromosomal information, amniocentesis with appropriate testing may be discussed.
What is O/E LHR?
O/E LHR means observed-to-expected lung-to-head ratio. It is an ultrasound-based way of comparing visible fetal lung size with what is expected for that stage of pregnancy. It helps counselling but cannot predict the future with certainty.
Is fetal MRI always required?
Fetal MRI is not always required, but it may be advised in selected cases to better estimate lung volume, liver position or anatomy before delivery planning.
Can CDH be treated before birth?
Most pregnancies need specialist monitoring and planned delivery. In selected severe cases, advanced fetal therapy options may be discussed at specialised fetal therapy centres. Dr. Kunda helps families understand whether such referral is relevant.
Where should a baby with CDH be delivered?
Delivery is generally planned at or linked with a tertiary centre where neonatal intensive care, ventilatory support and paediatric surgical expertise are available. This is decided with the obstetrician, fetal medicine specialist and neonatal team.
Does a normal-looking rest of anomaly scan mean everything is fine?
A reassuring detailed scan is helpful, but ultrasound has limitations. Continued follow-up, fetal echo, genetic counselling and delivery planning may still be needed depending on the case.
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Need a CDH fetal scan second opinion in Nagpur?
Book a detailed fetal medicine consultation with Dr. Kunda Shahane at Mayflower Fetal Medicine & High-Risk Pregnancy Centre, Dhantoli, Nagpur. Bring previous reports and images so the diagnosis and next steps can be reviewed properly.
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