Published online Sep 26, 2023. doi: 10.12998/wjcc.v11.i27.6440
Peer-review started: June 11, 2023
First decision: August 8, 2023
Revised: August 10, 2023
Accepted: August 29, 2023
Article in press: August 29, 2023
Published online: September 26, 2023
Processing time: 100 Days and 22 Hours
Diaphragmatic hernia (DH) is extremely rarely described during pregnancy. Due to the rarity, there is no diagnostic or treatment algorithm for DH in pregnancy.
Although rare, such cases can be found in clinical practice, and immediate intervention is necessary. Due to the lack of guidelines on the subject, it is difficult to make correct decisions. A review article on the subject would simplify the decision process.
To summarize and define the most appropriate diagnostic methods and therapeutic options for DH in pregnancy based on scarce literature.
A literature search of English-, German-, Spanish-, and Italian-language articles were performed using PubMed (1946–2021), PubMed Central (1900–2021), and Google Scholar. The PRISMA protocol was followed. Demographic, imaging, surgical, and obstetric data were obtained.
The average maternal age increased. The proportion of congenital hernias increased, while the other types appeared stationary. Most DHs were left-sided (83.8%). The median number of herniated organs declined. A working diagnosis was correct in 50%. DH type did not correlate to maternal or neonatal outcomes. Laparoscopic access increased while thoracotomy varied. Presentation of less than 3 d carried a significant risk of strangulation in pregnancy.
The clinical presentation of DH is easily confused with common chest conditions, delaying the diagnosis, and increasing maternal and neonatal mortality. Symptomatic DH should be included in the differential diagnosis of pregnant women with abdominal pain associated with dyspnea and chest pain, especially when followed by collapse. Early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes. Strangulated DH requires an emergent operation, while delivery should be based on obstetric indications.
Diagnostic, surgical, and obstetric findings of this study will shorten the diagnostic delay of DH. Also, earlier and more beneficial surgical and obstetric management would reduce maternal complications and fetal mortality.