Journal
ULTRASOUND IN OBSTETRICS & GYNECOLOGY
Volume 30, Issue 2, Pages 180-187Publisher
JOHN WILEY & SONS LTD
DOI: 10.1002/uog.4056
Keywords
esophageal atresia; prenatal diagnosis; ultrasound
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Objective Prenatal diagnosis of esophageal obstruction is believed to improve the outcome for the affected newborn. However, the prenatal detection rate is only 10-40%, the diagnosis is usually not made before the third trimester and the false-positive rate has been high. This study investigated the prenatal detection rate and time of prenatal diagnosis at our center and its influence on outcome. In addition, incidence, detection rate and accuracy of the diagnosis in a large non-selected population were determined. Methods All cases diagnosed pre- or postnatally with esophageal obstruction and examined prenatally by ultrasound at the National Center for Fetal Medicine in Norway during 1987-2004 were evaluated. Results Of 48 cases with esophageal obstruction, 21 (44 %) were diagnosed prenatally (median, 32 + 0 weeks). All 21 bad a small or empty stomach, 20/21 (95%) had polyhydramnios and 9/21 (43%) had a visible esophageal pouch. Associated anomalies were present in 38/48 cases (79%). The karyotype was abnormal in 11/48 cases (23%). Ten (21%) pregnancies with lethal fetal conditions were terminated. Two fetuses died in utero. Ten infants with associated anomalies died within 3 months after birth. The 26/48 (54%) survivors included 16/21 cases with a prenatal diagnosis of esophageal obstruction and 9/10 cases with isolated esophageal obstruction. Conclusions The clinical signs of polyhydramnios were the most important factors for prenatal detection of esophageal obstruction. Consequently, the time of diagnosis was late and the detection rate was low (44%). An increased awareness of the possibility of esopbageal obstruction, leading to targeted examinations whenever the suspicion is raised during pregnancy, might improve the prenatal detection rate and thereby provide a possibility to improve the outcome. Of the cases with isolated esopbageal obstruction, 90% survived, irrespective of Prenatal diagnosis. Copyright (c) 2007 ISUOG. Published by John Wiley & Sons, Ltd.
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