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Diaphragmatic Hernia
Background
The diaphragm is the muscular sheet which separates the chest from the abdomen. A congenital diaphragmatic hernia (CDH) is a defect or hole in the diaphragm which the bowel can pass through. Usually the diaphragm is fully formed by ten weeks of gestation, so any problem can be picked up on an eighteen week ultrasound scan. The commonest hole is on the left side, though they can occur on the right or at the front. Usually only part of the diaphragm is deficient, though an entire half-diaphragm may be missing.
Because of the hole, the bowel can go up through the diaphragm into the chest. This squashes the heart and both lungs. While in the womb, the placenta provides the oxygen for the baby, who will grow normally. However, the lungs may not develop normally, depending on how squashed they are and how long the bowel is in the chest. In some babies, the bowel only goes into the chest at delivery and so the lungs are normal. Other babies have lungs which are so poorly developed that they cannot keep the baby alive after delivery and the baby dies very quickly. Most affected babies are in between and have a degree of breathing difficulty.
Up to fifty per cent of babies with CDH have major associated problems, either with their heart, spinal cord, brain or chromosomes. These problems may be lethal.
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