Prognostic significance of nonvisualization of the fetal stomach by sonography.

Millener, P.; Anderson, N.; Chisholm, Richard J.

doi:10.2214/ajr.160.4.8456673

Cited by 37 publications

(22 citation statements)

References 6 publications

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“…Pretorius et al 2 repeated ultrasonography at 30–60 min and 1 week. Both Millener et al 3 and McKenna et al 4 used a 45 min interval scan. Our patients were asked to wait at least an hour before a rescan.…”

Section: Discussionmentioning

confidence: 99%

“…In their series of 27 cases of persistent non-visualisation, they identified eight aneuploid fetuses (38%). Millener et al 3 (n=31) described one infant with Down syndrome but did not report karyotyping uptake or results. Similarly, Pretorius et al 2 (n=19) only mention one case of triploidy.…”

Section: Discussionmentioning

confidence: 99%

“…This poses significant problems in diagnosis, counselling and management of these pregnancies. Only three publications have addressed this issue to date,2–4 the most recent of which was published over 15 years ago. All cases presenting to our unit over an 8-year period were retrospectively reviewed to define and quantify diagnoses and outcomes, and propose a management strategy for clinicians faced with non-visualisation of the fetal stomach on antenatal scans.…”

Section: Introductionmentioning

confidence: 99%

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

McKelvey

Stanwell

Smeulders

et al. 2010

Archives of Disease in Childhood - Fetal and Neonatal Edition

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

McKelvey

Stanwell

Smeulders

et al. 2010

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…Millener et al 13 reported that transient nonvisualization of the fetal stomach in an otherwise sonographically normal pregnancy was associated with neonatal morbidity in 33% of their cases and suggested that the poor outcomes were influenced by pregnancy-related maternal disorders. In our study, four fetuses with transient stomach nonvisualization (29%) were delivered preterm.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes Following Sonographic Nonvisualization of the Fetal Stomach

Brumfield

Davis

Owen

et al. 1998

Obstetrics & Gynecology

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Objective: To review pregnancy outcomes when two or more ultrasound scans persistently fail to visualize the fetal stomach.Methods: A computerized ultrasound database was used to identify all fetuses in which two or more serial ultrasound examinations failed to visualize the fetal stomach. Sonographic images were reviewed retrospectively, with the reviewer blinded to outcome data, to confirm persistent nonvisualization. Pregnancy outcome data were obtained from hospital charts and physicians' office records. Fetal karyotypes, when performed, were obtained from amniotic fluid (AF) culture. The ultrasound findings then were compared with fetal karyotype results and pregnancy outcome data.Results: Of 35,569 ultrasound scans performed during 1991-1996, 26 fetuses (0.07%) with persistently nonvisualized stomachs were identified. Structural defects were detected in 17 fetuses (65%), most often involving the cardiothoracic (n ‫؍‬ ‫؍‬ ‫؍‬ 5), genitourinary (n ‫؍‬ ‫؍‬ ‫؍‬ 4), and central nervous systems (n ‫؍‬ ‫؍‬ ‫؍‬ 4). Karyotypes were obtained in 12 fetuses, and four of them were abnormal. Only five of 17 fetuses (29%) with a structural defect survived. In nine of 26 fetuses (35%) with persistently nonvisualized stomachs, no structural defect was identified. Each of these nine fetuses had abnormal AF volume in its surrounding sac, and the overall perinatal survival in fetuses without a structural defect was only 50%.Conclusion: Fetuses with persistently nonvisualized stomachs have an increased incidence of structural defects and AF abnormalities and are more likely to have a poor outcome. A detailed ultrasound examination and fetal karyotype analysis should be performed to evaluate fetuses with persistently nonvisualized stomachs. (Obstet Gynecol 1998; 91:905-8.

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“…The prenatal sonographic detection of EA relies on the finding of a small or nonvisualizable fetal stomach bubble associated with polyhydramnios (12). However, because of the large number of etiologies for these two signs (13,14) and to the subjective nature of a small fetal stomach (12,15,16), EA prenatal diagnosis remains difficult and is characterized both by a high false-positive rate and a poor detection rate. Several studies have documented that the sensitivity of sonography ranges from 8.9 to 42% (6,(17)(18)(19)(20)(21)(22) with Sparey et al (19) reporting a 44% positive predictive value and Stringer et al (22) 56%.…”

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confidence: 99%

Biochemical Amniotic Fluid Pattern for Prenatal Diagnosis of Esophageal Atresia

et al. 2011

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Prenatal diagnosis of esophageal atresia (EA) may improve the outcome of affected neonates by allowing optimization of both prenatal and postnatal care. Prenatal sonographic detection is based on polyhydramnios and/or nonvisualization of the fetal stomach bubble, two signs with a large number of etiologies. We evaluated a biochemical approach to improving diagnostic efficiency. We compared amniotic fluid biochemical markers in 44 EA cases with 88 polyhydramnios and 88 nonpolyhydramnios controls. Both matched for GA with cases. Total proteins, alpha-fetoprotein (AFP), and digestive enzyme activities were assayed, including gamma-glutamyl transpeptidase (GGTP). We defined an EA index (AFP multiplied by GGTP). A significant difference (p Ͻ 0.0001) was observed for total protein, AFP, GGTP, and EA index between the EA group and each of the two control groups. No statistical difference was observed for any marker between the two most frequent EA subgroups (type I and type III) or between the two control groups. Using a cutoff of 3 for the EA index, 98% sensitivity and 100% specificity were observed for amniotic fluid prenatal diagnosis of EA, whatever the anatomical type. A large prospective series is required to confirm these results.

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Prognostic significance of nonvisualization of the fetal stomach by sonography.

Cited by 37 publications

References 6 publications

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

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

Pregnancy Outcomes Following Sonographic Nonvisualization of the Fetal Stomach

Biochemical Amniotic Fluid Pattern for Prenatal Diagnosis of Esophageal Atresia

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