What causes Congenital Diaphragmatic Hernia?

In a growing embryo, the diaphragm is completely formed by 10 weeks of gestation. However in cases of Congenital diaphragmatic hernia, the process that leads to formation of the diaphragm is disrupted. Once there is a hole present in the diaphragm, abdominal contents can move into the chest. This is called herniation. Because fetal activity and breathing movements become more frequent and vigorous as a pregnancy continues, the amount of herniation can fluctuate or increase.

Sometimes Congenital diaphragmatic hernia is caused by a problem with a baby’s chromosomes or by a genetic disorder. If this is the case, the baby may have additional medical problems or organ abnormalities. In other instances, Congenital diaphragmatic hernia may occur without an identifiable genetic cause. This is called “isolated Congenital diaphragmatic hernia”, and under these circumstances the primary concern is the degree of pulmonary hypoplasia caused by the defect. In order to determine if Congenital diaphragmatic hernia is isolated and to provide the most correct information about the disease, genetic testing is required.

Diagnosis

Detection of CDH may come during a routine ultrasound, which may reveal excess amniotic fluid and/or abdominal contents in the fetal chest cavity. To confirm a prenatal diagnosis of Congenital diaphragmatic hernia, doctors may perform a very detailed ultrasound, conduct testing of the fetus’s chromosomes and take measurements of its lung size. During the ultrasound examination, doctors focus on specific findings that may point to the presence of a syndrome. The genetic testing is performed by amniocentesis.

The lung size is then measured and compared to the expected size at this stage of a pregnancy. This can be done by measuring the lung area to head circumference ratio (LHR) or comparing the observed/expected LHR (o/e LHR). It is also important to determine whether the liver has also moved into the chest. Based on these measurements, specialists at the Johns Hopkins Center for Fetal Therapy can grade the severity of Congenital diaphragmatic hernia as mild, moderate or severe. Magnetic resonance imaging (MRI) are used to help achieve the most accurate assessment.

Congenital diaphragmatic hernia may also be diagnosed after birth — often if a newborn is having trouble breathing.

Allopathic Treatment

Following delivery, a baby with CDH may undergo surgery to close the defect. However, surgery after delivery does not address the lung damage that has already occurred. For this reason, fetal therapeutic procedures are recommended in some pregnancies. These procedures may help decrease the amount of lung damage that can occur during the pregnancy. The goal of fetal treatment is to reverse some of the lung damage that results from compression of the lungs.

Fetal Treatment for CDH

• Fetoscopic tracheal occlusion (FETO): The fetal lungs produce fluid that leaves the body through the baby’s mouth. If this outflow of fluid is blocked, it has nowhere to go and swells up in the affected lung. When this occurs over a period of four to five weeks, the lung expands and its function appears to improve. This type of blockage can be achieved by temporarily blocking the fetal windpipe (trachea) with a balloon for a period of time. This is done by performing operative fetoscopy, known as FETO. It is believed that FETO works by increasing the lung maturation and reversing some of the damaging effects of CDH on lung function.

• Fetal surveillance and delivery planning: There is a high possibility that a baby with CDH will get worse before the anticipated due date. Part of a comprehensive treatment plan will involve close fetal and maternal monitoring to avoid severe fetal deterioration and to determine the circumstances and timing for optimal delivery.

Homeopathic treatment for Congenital Diaphragmatic Hernia

Hernia is a surgical condition, but it can be corrected by well selected Homoeopathic medicines.

Nux Vomica

Bruised soreness of abdominal walls (Apis; Sulph). Flatulent distension, with spasmodic colic. Colic from uncovering. Liver engorged, with stitches and soreness. Colic, with upward pressure, causing short breath, and desire for stool. Weakness of abdominal ring region. Strangulated hernia (Op). Forcing in lower abdomen towards genitals. Umbilical hernia of infants.

Apis Melifestida

Sore bruised on pressure when sneezing. Extremely tender. Dropsy of abdomen. Peritonitis. Swelling in right groin.

Allium Cepa

Rumbling in bowels. Very offensive flatus. Strangulated hernia. Belching, with rumbling in and puffing up of the abdomen. Violent cutting pain in the left lower abdomen. Pains in hepatic region, spreading into the abdomen. Violent pains in left hypogastrium, with urging to urinate, urine scalding. (Strangulated hernia has been known to follow the eating abundantly of cooked onions). Abdomen distended, rumbling, urging, and finally diarrhoea.

Calceria Carbonica

Sensitive to slightest pressure. Liver region painful when stooping. Cutting in abdomen; swollen abdomen. Incarcerated flatulence. Inguinal and mesenteric glands swollen and painful. Cannot bear tight clothing around the waist. Distention with hardness. Gall-stone colic. Increase of fat in abdomen. Umbilical hernia. Trembling; weakness, as if sprained.

Cocculus Indicus

Distended, with wind, and feeling as if full of sharp stones when moving; better, lying on one side or the other. Pain in abdominal ring, as if something were forced through. Abdominal muscles weak; it seems as if a hernia would take place.

Aurum Metallicum

Right hypochondrium hot and painful. Incarcerated flatus. Swelling and suppuration of inguinal glands. Hernia. Burning heat and cutting pain in hypochondrium. Abdomen inflated. Exostosis in the pelvis. Tendency of hernia to protrude, sometimes with cramp-like pains and incarcerated flatus. Swelling of the (lower part) of the testicle. Swelling of the testes, with aching pain on touching and rubbing. Induration of the testes. Testes mere pendant shreds (in pining boys). Hydrocele. Prolapsus and induration of the matrix. Swelling of axillary glands.

Rhus Toxicodendron

Violent pains, relieved by lying on abdomen. Swelling of inguinal glands. Pain in region of ascending colon. Colic, compelling to walk bent. Excessive distention after eating. Rumbling of flatus on first rising, but disappears with continued motion.

Lachesis

Enlargement of abdomen. Hernia. Pains in abdomen, in consequence of a strain in the loins. Pains generally pressive in umbilical region with acute pullings, with contraction of abdomen. Peritonitis; pus formed. Inflammation of intestines. Extravasation of blood in peritoneum. Swelling in caecal region; must lie on back, with limbs drawn up. Pressure in testes, as if a hernia were going to protrude.

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Lycopodium Clavatum

Hernia, right side. Liver sensitive. Brown spots on abdomen. Dropsy, due to hepatic disease. Hepatitis, atrophic from of nutmeg liver. Pain shooting across lower abdomen from right to left. Tension round hypochondria. Burning pain in the abdomen. Hernia. Excoriation between scrotum and thighs. Dropsical swelling of genital organs.

Silica Tera

Swelling and induration of hepatic region. Shootings in hypochondria. Painful inguinal hernia. Swelling of prepuce.

Opium

Abdomen hard, and distended, as in tympanites. Tympanites. Lead-colic. Incarcerated inguinal hernia.

Bryonia Alba

Pains in the liver, mostly shooting, tensive, or burning. Hernia. Tractive pains in the hypochondrium. Hard swelling in the hypochondriac and umbilical regions. Hard swelling around the navel. Swelling and inflammation of the labia majora. Swelling of one of the labia, with a black and hard pustule.

Tabacum

Great sensitiveness of abdomen to slightest touch sometimes with nausea and vomiting. Pressive pains in umbilical region, with spasmodic retraction. Genital organs flabby. Varicocele.

Hydrocotyle Asiatica

Scleroderma, elephantiasis, leprosy, skin thickened, itching and hardened. Constipation. Favus. Gangrene. Borborygmi in different parts. Flatus. Violent contractions of intestines. Pain; every few minutes; transverse colon. Constriction. Drawing in spermatic cords. Vulva, vagina and cervix red. Heat in bottom of vagina; pricking and itching at its orifice.

Plumbum Metallicum

Inflation and induration of abdomen. Violent colics, with constrictive pain, especially in umbilical region. Large, hard swelling in ileocecal region, very sensitive to contact or least motion; sneezing or coughing. Inflammation, ulceration and gangrene of intestines. Swelling and inflammation of genital organs.

Chamomilla

Burning cuttings in the epigastrium, with difficulty of respiration, and paleness of the face. Shooting in the abdomen, principally on coughing, on sneezing, and on touching it. Painful sensibility of the abdomen to the touch, with sensation of ulceration in the interior. Inguinal hernia; pressure towards the inguinal ring, as if hernia were about to protrude. Abdominal spasms. Hernia to prepuce.

Belladonna

Violent pain in the abdomen,-Shootings in sides of the abdomen, on coughing, on sneezing, and on being touched. Pains and burning in the hypochondria. Pressure in the abdomen. Hernia. Hernia hypochondria. Hernia to the prepuce. In women: Violent pressure towards the genital parts, as if all were going to protrude, principally when walking, or when in a crouching posture. Shooting in the internal genital parts.

Aconit Nepalus

Constriction, tension and pressure in the hypochondriac region, sometimes with fullness and a sensation of weight. Burning pain, shootings, stinging and pressure; Hernia. Testicles feel swollen, painful to touch; hernia. Puerperal peritonitis.

Aesculus Hippocastanum

Tenderness in the hypochondrium. with much distress in epigastrium. Hernia. Inflamed cervix uteri, retroversion, prolapsus, enlargement and induration, when characterised by great tenderness heat and throbbing.

AurumMetallicum

Burning heat and cutting pain in hypochondrium. Colic with sensation of great uneasiness and inclination to evacuate. Tensive aching and fullness in the abdomen. Abdomen inflated. Exostosis in the pelvis. Tendency of hernia to protrude, sometimes with cramp-like pains and incarcerated flatus. Swelling and suppuration of the inguinal glands from syphilis or the use of mercury. Swelling of the testes, with aching pain on touching and rubbing. Induration of the testes. Testes mere pendant shreds. Hydrocele. Prolapsus and induration of the matrix, prolapse of rectum.

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Magnesium Muriaticum

Pressing pain in liver; worse lying on side. Liver enlarged with bloating of abdomen; Congenital scrotal hernia, must use abdominal muscles to enable him to urinate. Violent and constant distension of abdomen, with constipation. hernia to testicles.

Calceria Phosphoricum

Hernia. Hydrocele. Malnutrition. Weak and pale with flabby muscles. Colic, soreness and burning around navel.

Cocculus Indicus

Distended, with wind, and feeling as if full of sharp stones when moving; better, lying on one side or the other. Pain in abdominal ring, as if something were forced through. Abdominal muscles weak;Hernia. Painful pressing in uterine region, followed by haemorrhoids.

Granatum

Pain in stomach and abdomen; worse about umbilicus; ineffectual urging. Itching at anus. Dragging in vaginal region, as if hernia would protrude. Swelling resembling umbilical hernia.

Staphysagria

Hot flatus. Swollen abdomen in children, flatus, colic and pelvic tenesmus. Severe pain abdominal hernia. Incarcerated flatus. Diarrhoea after drinking cold water, with tenesmus. Constipation.  Haemorrhoids. Prolapsus uteri.  Cystocele (locally and internally). Cystitis in lying-in patients.