Diaphragmatic Hernia and Its Complications During Pregnancy and Labor.

Introduction

Diaphragmatic hernia is a congenital disability, and the diaphragm is a large muscle separating the chest from the abdomen. The diaphragm shape is dome-shaped. There is a hole in the diaphragm through which the internal organs push; due to this, there is a hernia. A diaphragmatic hernia develops in newborns, and also those with diaphragmatic hernia develop defects of the brain, heart, and intestine. One in three thousand newborns develop a diaphragmatic hernia. The diaphragmatic hernia is a medical emergency and causes complications during gestation and labor.

What Are the Types Of Diaphragmatic Hernia?

The diaphragmatic hernia has two types:

• Congenital diaphragmatic hernia (CDH).

• Acquired diaphragmatic hernia (ADH).

What Are the Causative Factors of Diaphragmatic Hernia?

The causative factors for congenital diaphragmatic hernia are:

• During the embryo's growth in the womb, the diaphragm development is not normal.

• A hole in the diaphragm of the fetus leads to abdominal organs moving into the chest and occupying the space where the lungs are positioned. The result of this is the lung cannot develop properly.

The causative factors for acquired diaphragmatic hernia are:

• As a result, blunt or penetrating injury leads to acquired diaphragmatic hernia (ADH).

• Traffic accidents are a reason for blunt injuries.

• Accidental falls are the reason for the majority of blunt injuries.

• Stabbing causes penetrating injuries.

• Gunshot wounds cause penetrating injuries.

• Surgery in the abdomen or chest can also cause accidental damage to the diaphragm.

• The hernia can also develop without reason and is undiagnosed for a long time until severe symptoms appear.

What Are the Complications of Diaphragmatic Hernia?

• Breathing Difficulty: This is very severe in a diaphragmatic hernia. In chronic diaphragmatic hernia, there is abnormal development of the lungs. In acute diaphragmatic hernia, the lungs cannot function properly due to the pushing of internal organs.

• Tachypnea: Tachypnea means rapid breathing. The lungs function at a faster rate and compensate for the decreased levels of oxygen in the body.

• Cyanosis: Cyanosis means bluish discoloration of the skin and nails. The reason for this is the body does not receive enough oxygen from the lungs.

• Tachycardia: Tachycardia means rapid heart rate. The heart pumps blood at an elevated rate than normal to supply oxygenated blood to the body.

• Decreased Breath Sounds: The absence or diminished breath sounds is a common sign of a diaphragmatic hernia. The baby's lungs are not formed properly. The breath sounds are so feeble on the side, which is affected.

• Changes in the Chest Region: The bowel sounds appear in the chest region when the intestine moves up the chest cavity.

• Abdomen Changes: The abdomen is not full as normal upon palpation (examination of the body by pressing certain areas). This is because abdominal organs are pushed up into the chest region.

What Are the Etiological Risk Factors for Diaphragmatic Hernias?

The risk factors for congenital diaphragmatic hernia are chromosomal and genetic abnormalities, nutritional problems, and environmental exposure. The risk factors for acquired diaphragmatic hernia are stab wounds, gunshot wounds, surgical procedures, and blunt injuries.

What Is the Diagnosis of a Diaphragmatic Hernia?

• The physicians diagnose the congenital diaphragmatic hernia before the delivery of the baby.

• Half of the cases are identified during an ultrasound examination of the fetus.

• There is an elevated amount of amniotic fluid (the fluid that surrounds and shields the fetus) in the uterus (womb).

During the physical examination, the following changes occur:

• After the baby's birth, there are abnormal chest movements.

• Breathing is difficult.

• Cyanosis means bluish discoloration of the skin and nails.

• Absence of breath sounds on one side of the chest.

• There are bowel sounds heard in the chest.

• There is an empty feeling in the abdomen.

The following are the basic diagnostic tests for the detection of diaphragmatic hernia:

• X-rays.

• Ultrasound: Ultrasound scanning (use of non-invasive ultraviolet rays to produce images of abdominal and thoracic cavities).

• Computerized Tomography (CT) Scan: Computerized tomography (facilitates a direct view of the abdominal organs).

• Arterial Blood Gas Test: In the arterial blood gas test, the blood is taken directly from an artery and tests for oxygen, carbon dioxide, and acidity.

• MRI Scan: Magnetic resonance imaging is a more focused detection of organs in the fetus.

What Is the Treatment for Diaphragmatic Hernia?

• The congenital and acquired diaphragmatic hernia are medical emergencies and require immediate surgery.

• Surgery is essential to remove the abdominal organs from the chest and place them back in the abdomen.

• The physician will repair the diaphragm.

• In congenital diaphragmatic hernia, the physicians perform the surgery as early as forty-eight to seventy-two hours after the baby is delivered. The surgery may be completed early in emergencies, or it may be delayed.

• The stabilization of the baby is essential and increases oxygen levels. Various methods and techniques are used to stabilize the newborn and assist with breathing.

• The care for the newborns is at the neonatal intensive care unit (NICU).

• Patients who develop a diaphragmatic hernia due to injury have other complications like internal bleeding and must be stabilized before the surgery.

How to Prevent a Diaphragmatic Hernia?

There is no way to prevent congenital diaphragmatic hernia. Early detection and diagnosis of diaphragmatic hernia are essential for proper care and immediate treatment. Early detection facilitates proper planning and care before, during, and after the delivery.

The preventive methods for acquired diaphragmatic hernia are:

• Advised to drive safely and always wear a seat belt.

• Inhibit activities that make one prone to significant blunt injuries to the chest or abdomen.

• Recommended to limit drinking alcohol.

• Medication that causes drowsiness must be avoided while driving.

• Avoid exercising near sharp objects.

What Is the Survival Rate of Diaphragmatic Hernia Individuals?

• The congenital diaphragmatic hernia cases, the survival rate is seventy to ninety percent in the long run. The factors under consideration are the magnitude to which the lungs are damaged and the severity of the effect on other internal organs.

• In acquired diaphragmatic hernia cases, the survival rate depends on age, type of injury, and overall health of the individual. Also, should take the severity of the hernia should be under consideration.

Conclusion

Diaphragmatic hernia is a serious medical emergency and can be life-threatening. The treatment must be provided immediately. Should stabilize the patient before surgery to avoid internal bleeding. Proper prenatal care and frequent scanning during gestation to prevent complications.