4.6 Article

Esophageal atresia and tracheoesophageal fistula: prenatal sonographic manifestation from early to late pregnancy

Journal

ULTRASOUND IN OBSTETRICS & GYNECOLOGY
Volume 58, Issue 1, Pages 92-98

Publisher

WILEY
DOI: 10.1002/uog.22050

Keywords

absent stomach; esophageal atresia; esophageal pouch; polyhydramnios; small stomach; tracheoesophageal fistula

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The prenatal diagnosis of esophageal atresia and/or tracheoesophageal fistula is typically not feasible before the late second trimester. The detection rates of suspected cases increase with advancing pregnancy, peaking in the third trimester. Early and mid-trimester anomaly scans perform poorly as a screening and diagnostic test for these conditions.
Objective Esophageal atresia and/or tracheoesophageal fistula (EA/TEF) remains one of the most frequently missed congenital anomalies prenatally. The aim of our study was to elucidate the sonographic manifestation of EA/TEF throughout pregnancy. Methods This was a retrospective study of data obtained from a tertiary center over a 12-year period. The prenatal ultrasound scans of fetuses with EA/TEF were assessed to determine the presence and timing of detection of three principal signs: small/absent stomach and worsening polyhydramnios, both of which were considered as 'suspected' EA/TEF, and esophageal pouch, which was considered as 'detected' EA/TEF. We assessed the yield of the early (14-16 weeks' gestation), routine mid-trimester (19-26 weeks) and third-trimester (>= 27 weeks) anomaly scans in the prenatal diagnosis of EA/TEF. Results Seventy-five cases of EA/TEF with available ultrasound images were included in the study. A small/absent stomach was detected on the early anomaly scan in 3.6% of fetuses scanned, without a definitive diagnosis. On the mid-trimester scan, 19.4% of scanned cases were suspected and 4.3% were detected. On the third-trimester anomaly scan, 43.9% of scanned cases were suspected and 33.9% were detected. An additional case with an esophageal pouch was detected on magnetic resonance imaging (MRI) in the mid-trimester and a further two were detected on MRI in the third trimester. In total, 44.0% of cases of EA/TEF in our cohort were suspected, 33.3% were detected and 10.7% were suspected but, eventually, not detected prenatally. Conclusions Prenatal diagnosis of EA/TEF on ultrasound is not feasible before the late second trimester. A small/absent stomach may be visualized as early as 15 weeks' gestation. Polyhydramnios does not develop before the mid-trimester. An esophageal pouch can be detected as early as 22 weeks on a targeted scan in suspected cases. The detection rates of all three signs increase with advancing pregnancy, peaking in the third trimester. The early and mid-trimester anomaly scans perform poorly as a screening and diagnostic test for EA/TEF. (c) 2020 International Society of Ultrasound in Obstetrics and Gynecology.

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