The cause of death in congenital diaphragmatic hernia is –
(A) Septicaemia (B) Hemorrhage (C) Pulmonary hypoplasia (D) Intestinal obstruction
(C) Most common cause of death in congenital diaphragmatic hernia is                       Pulmonary complications
2"d most common cause of death in congenital diephragmatic hernia in  ---> Intestinal obstruction

Congenital diaphrogmatic hernia

Also known as ochalek hernia.
There is herniation of abdominal contents, i.e. stomach (most of the time), intestine, liver; into thorax through a defect in the diaphragm.
Females are affected more than males
More common on left side and is posterolateral.
Components of CDH are


Herniation of abdominal contents into thorax
Pulmonary hypoplasia
Malrotation of intestine


Associated anomalies may be seen 30% of cases -> CNS lesions, esophageal atresia, omphalocele and CVS lesions.
Most cases are sporadic.
CDH is a reconized part of several chromosomal syndromes ---> Trisomy 21, 18, 13, turner syndrome, Pallister-Killian, Fryn.

Clinical features

CDH may present as


Soon (within 6 hrs) after birth (most of the cases)
	or
After neonatal period (small group)

1)   Soon after birth

Respiratory distress is a cardinal sign --> presents as tachypnea, grunting, chest retraction, cyanosis.
Scaphoid abdomen
Increased chest wall diameter
Bowel sounds may be heard in the chest with decreased breath sound.


Cardiac impulse is displaced away from the side of hernia.

2)   After neonatal period

Vomiting as a result of intestinal obstruction
Mild respiratory symptoms


Occasionally, incarceration of the intestine will proceed to ischemia with sepsis and shock.

Diagnosis

Prenatal ultrasound can diagnose CDH between 16 and 14 wk.
After delivery chest X-ray and nasal gastric tube is all that is usually required to confirm the diagnosis.