Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Maternal diaphragmatic hernia in pregnancy: A systematic review with a treatment algorithm
Goran Augustin, Diana Kovač, Vesna Sokol Karadjole, Vendy Zajec, Mislav Herman, Pero Hrabač
Goran Augustin, Department of Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Goran Augustin, Chair of Surgery, School of Medicine University of Zagreb, Zagreb 10000, Croatia
Diana Kovač, Institute of Emergency Medicine of Dubrovnik-Neretva County, Croatian Institute of Emergency Medicine, Dubrovnik 20000, Croatia
Vesna Sokol Karadjole, Department of Gynaecology and Obstetrics, University Clinical Hospital Centre Zagreb, Zagreb 10000, Croatia
Vendy Zajec, Mislav Herman, Department of Gynaecology and Obstetrics, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Pero Hrabač, Department of Biostatistics, "Andrija Štampar" School of Public Health, Zagreb 10000, Croatia
Pero Hrabač, Department of Biostatistics, School of Medicine University of Zagreb, Zagreb 10000, Croatia
Author contributions: Augustin G, Karadjole VS, and Hrabač P contributed to manuscript writing; Augustin G, Kovač D, and Zajec V contributed to data collection; Augustin G, Kovač D, Zajec V, and Herman M contributed to data analysis; Karadjole VS contributed to supervision; Hrabač P contributed to statistical analysis.
Conflict-of-interest statement: We declare that we have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Goran Augustin, MD, MSc, PhD, Associate Professor, Doctor, Senior Scientist, Surgical Oncologist, Department of Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia. augustin.goran@gmail.com
Received: June 11, 2023
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
ARTICLE HIGHLIGHTS
Research background
Diaphragmatic hernia (DH) is extremely rarely described during pregnancy. Due to the rarity, there is no diagnostic or treatment algorithm for DH in pregnancy.
Research motivation
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.
Research objectives
To summarize and define the most appropriate diagnostic methods and therapeutic options for DH in pregnancy based on scarce literature.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
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.
