Congenital Diaphragmatic Hernia Anomaly in Multigravida at 36 Weeks Gestation with One Previous Cesarean Section, Single Live Fetus, Cephalic Presentation: Case Report

Asri Indriyani Putri; Abarham Martadiansyah; Nuswil Bernolian; Muhammad Al Farisi Sutrisno; Rizania Raudhah Nisfita; Rahma Maharsi

doi:10.24198/obgynia.v7i2.613

Congenital Diaphragmatic Hernia Anomaly in Multigravida at 36 Weeks Gestation with One Previous Cesarean Section, Single Live Fetus, Cephalic Presentation: Case Report

Asri Indriyani Putri, Abarham Martadiansyah, Nuswil Bernolian, Muhammad Al Farisi Sutrisno, Rizania Raudhah Nisfita, Rahma Maharsi

Abstract

Background: Case of a multigravida at 36 weeks of gestation with one previous cesarean section carrying a single fetus was diagnosed with diaphragmatic hernia. This case aims to address the challenges posed by this complex scenario of diaphragmatic hernia and the importance of specialized care to ensure optimal maternal and fetal outcomes.
Case Report: Referred from Muhammadiyah Hospital Palembang, the patient at 36 weeks of gestation with G3P2A0 status present a single live fetus and was diagnosed with diaphragmatic hernia. Following prior midwife care where fetal heartbeats were not detected, the patient was referred to Dr. Mohammad Hoesin Central General Hospital Palembang. The management plan includes a one-week follow-up and folic acid, calcium carbonate, and iron supplementation.
Discussion: Congenital diaphragmatic hernia (CDH) is a developmental defect causing diaphragmatic discontinuity, diagnosed prenatally with 40% to 90% accuracy via ultrasound. The treatment aims to minimize lung hypoplasia and reduce mortality, typically performed at 26-28 weeks for severe cases and 30-32 weeks for moderate ones. The optimal delivery timing for CDH remains controversial, with lung-to-head ratio as a widely used prognostic indicator.
Conclusion: Congenital diaphragmatic hernia (CDH) exhibits lower survival rates on the right side (50% vs. 75%), with lung area to head circumference ratio (LHR) as a common prognostic parameter. Recent minimally invasive techniques like FETO aim to improve prognosis by reducing pulmonary hypoplasia and mortality.

Laporan Kasus: Multigravida Hamil 36 Minggu Belum Inpartu Bekas Seksio Sesarea Satu Kali Janin Tunggal Hidup Presentasi Kepala Dengan Anomali Kongenital Hernia Diafragmatik

Abstrak
Latar Belakang: Kasus multigravida hamil 36 minggu dengan riwayat operasi caesar janin tunggal hidup yang didiagnosis hernia diafragma. Tujuan laporan kasus ini untuk mengatasi tantangan yang ditimbulkan oleh skenario kompleks hernia diafragma dan menunjukkan pentingnya perawatan khusus untuk memastikan hasil akhir ibu dan janin yang optimal.
Laporan Kasus: Pasien usia kehamilan 36 minggu dengan status G3P2A0 janin hidup tunggal dengan diagnosis hernia diafragma dirujuk dari RS Muhammadiyah Palembang setelah sebelumnya diperiksa oleh bidan dan tidak terdeteksi detak jantung janinnya sehingga memerlukan rujukan ke RSUP Dr. Mohammad Hoesin Palembang. Rencana penatalaksanaannya mencakup tindak lanjut selama satu minggu, bersamaan dengan suplementasi asam folat, kalsium karbonat, dan zat besi.
Diskusi: Hernia diafragma kongenital (CDH) merupakan kelainan perkembangan yang menyebabkan diskontinuitas diafragma dan didiagnosis sebelum lahir dengan akurasi 40% hingga 90% melalui ultrasonografi. Tatalaksana bertujuan untuk meminimalkan hipoplasia paru-paru dan mengurangi angka kematian, biasanya dilakukan pada minggu ke 26 sampai 28 untuk kasus yang parah dan 30 - 32 minggu untuk kasus yang sedang. Waktu persalinan yang optimal untuk CDH masih kontroversial, dengan rasio paru-paru sebagai indikator prognosis yang banyak digunakan.
Kesimpulan: Hernia diafragmatika kongenital (CDH) menunjukkan tingkat kelangsungan hidup yang lebih rendah pada sisi kanan (50% vs. 75%), dengan rasio area paru terhadap lingkar kepala (LHR) sebagai parameter prognosis yang umum; teknik invasif minimal terkini bertujuan untuk meningkatkan prognosis dengan mengurangi hipoplasia paru dan kematian.

Kata kunci: Hernia Diafragma Kongenital, Riwayat Operasi Caesar Sebelumnya, Multigravida

Keywords

Congenital Diaphragmatic Hernia, Prior Cesarean Section

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DOI: http://dx.doi.org/10.24198/obgynia.v7i2.613