Which statement about congenital diaphragmatic hernia (CDH) is true?

• A. Antenatal Diagnosis is Associated with a Poor Prognosis
• B. Antenatal Steroids and Postnatal Surfactant Replacement have been Shown to be Beneficial
• C. Surgical Repair is Recommended Immediately upon Delivery
• D. Antenatal Surgery is Routinely Performed

Answer: (A)

Antenatal identification of CDH typically signals more severe disease because herniation of abdominal contents into the chest during fetal life leads to major lung hypoplasia and a higher risk of persistent pulmonary hypertension after birth. These factors drive higher mortality and morbidity, so detecting CDH before birth is generally a marker of worse prognosis, despite advances in perinatal care and delivery planning.

The other statements don’t reliably improve outcomes in the way the options imply. Antenatal steroids have not proven a clear, consistent benefit for CDH, and postnatal surfactant may help with respiratory distress but doesn’t change the fundamental prognosis driven by lung underdevelopment. Surgical repair is not performed immediately at delivery; typically repair is timed after stabilization and optimization of pulmonary hypertension. Antenatal surgery is not routinely performed and remains experimental in most centers.