Persistent non-visualisation of the fetal stomach: diagnostic and prognostic implications

Abstract

Persistent non-visualisation of the fetal stomach in the antenatal period was associated with a wide range of underlying diagnoses. In many cases, prognosis was poor. Only 37% of pregnancies resulted in liveborn infants surviving more than 6 months. The incidence of an abnormal karyotype was 29%. Diagnosis and outcome was normal in only 9.2% of cases. We propose an algorithm for the management of persistent non-visualisation of the fetal stomach on antenatal ultrasound.

Prognostic value of prenatally detected small or absent fetal stomach with particular reference to oesophageal atresia

“…Our data are in keeping with previous case series of antenatal small/absent stomach, which found 15%–50% liveborn infants had OA ±TOF, with a higher incidence with absent prenatal stomach and polyhydramnios 1–4. Our stratification into subsets allows us to predict OA ±TOF with greater certainty.…”

Performance of diagnostic ultrasound to identify causes of hydramnios

“…In our series, the most frequent malformation causing hydramnios was esophageal atresia (n = 6), with five of the cases diagnosed by ultrasound, one by visualization of a distended hypopharynx, and the other suspected by a persistent non‐visualization of the fetal stomach associated with the hydramnios. However, a “small stomach” is a subjective sign and can be associated with a wide range of pathologies 15,16 . Only the presence of a blind esophageal pouch is a certain diagnosis.…”

“…However, a "small stomach" is a subjective sign and can be associated with a wide range of pathologies. 15,16 Only the presence of a blind esophageal pouch is a certain diagnosis. A distended hypopharynx is a novel and sensitive sign that can lead to diagnosis of esophageal atresia (once in our series).…”

Esophageal atresia in twins compared to singletons: In utero manifestation and characteristics

“…Previous studies show that only a third of fetuses exhibiting a small/absent stomach with polyhydramnios and up to 10% cases of small/absent stomachs without polyhydramnios, have EA/TEF. 8,10 The rest are either normal or have other underlying entities such as neuromuscular abnormalities, pharyngeal obstruction. [7][8][9][10] Therefore, it is imprecise to discuss the performance of ultrasound in detecting EA/TEF in studies that have considered indirect signs as diagnostic.…”

“…Prenatal detection relies on three sonographic clues: polyhydramnios, absent or small stomach bubble and an esophageal pouch-the dilated blind-end of the upper esophageal segment. 4,5 While, polyhydramnios and small/absent stomach bubble are not highly specific for the diagnosis of EA/TEF and can be found in a variety of different conditions, [6][7][8][9][10] an esophageal pouch, when identified correctly, is diagnostic of EA with a reported 100% positive predictive value. 5,[11][12][13] Fetal MRI has been found to further improve the diagnostic accuracy of EA/TEF.…”