In which scenario is termination considered for congenital diaphragmatic hernia during pregnancy?

In the context of congenital diaphragmatic hernia (CDH), the consideration for termination of pregnancy is primarily influenced by the severity of the condition and fetal viability. When a fetus is diagnosed with CDH, particularly before 24 weeks of gestation, the prognosis is often poor due to significantly compromised lung development.

At this early stage, the lungs are not fully developed, and if there is a severe form of CDH, the likelihood of survival after birth may be minimal. The underdeveloped lungs can lead to profound respiratory distress and associated complications, which often do not offer a favorable outcome even with surgical interventions postnatally.

Thus, termination at this stage is considered in light of these serious concerns, allowing parents to make a decision that could prevent suffering for the fetus. In contrast, if the gestational age is over 34 weeks, or if the fetus shows signs of distress but has a better chance of survival with intervention, the option for termination may not be appropriate. Additionally, while the absence of lung development (not specific to gestational age) can signal severe issues, the decision-making process heavily weighs gestational age, where the potential for viability outside the womb is assessed.

Therefore, gestational age under 24 weeks