Fetal determinants of neonatal respiratory outcomes

Based on the above-mentioned considerations, the aims of this thesis are the following:
1. To review the existing literature on prenatal ultrasound assessment of pulmonary vasculature in fetuses with CDH.
2. To evaluate the association between fetal pulmonary vascular parameters and the position of intrathoracic organs such as the stomach, and the relation to postnatal (respiratory) outcomes in CDH.
3. To assess the additional diagnostic yield of exome sequencing in the genetic analysis of prenatally detected CDH.
4. To study the impact of maternal early-onset preeclampsia on fetal pulmonary vascular development.
A systematic literature review on prenatal ultrasound assessment of the pulmonary vasculature in CDH is presented in Chapter 2. In Chapter 3 we examined the relationship between fetal pulmonary artery measurements and postnatal ductus arteriosus flow. In Chapter 4 the association of prenatal stomach position and volume with postnatal respiratory outcomes in left-sided CDH is investigated. In Chapter 5 we present the diagnostic yield of exome sequencing in a nationwide cohort of fetuses with CDH. The effects of early-onset preeclampsia on fetal pulmonary vascular development is explored in Chapter 6. In Chapter 7 the findings of this thesis, their clinical implications, and future research perspectives is being discussed, and in Chapter 8 this thesis is summarized.
Together, these studies provide a comprehensive insight into the prenatal prediction of respiratory outcomes in CDH, combined with genetic evaluation of these fetuses. In addition, as a proof of concept the effects of preeclampsia on fetal pulmonary vascular development are explored. By integrating these findings, this thesis aims to contribute to the prenatal prediction of respiratory outcomes of these fetuses at risk for respiratory morbidity.