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KMID : 1143220210640010042
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Obstetrics & Gynecology Science
2021 Volume.64 No. 1 p.42 ~ p.51
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Prenatal ultrasonographic findings of esophageal atresia: potential diagnostic role of the stomach shape
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Chang Chi-Son
Choi Yun-Sun
Kim Seo-Yeon
Yee Cheong-A
Kim Mi-Na
Sung Ji-Hee
Lee Sang-Hoon
Choi Suk-Joo
Oh Soo-Young
Seo Jeong-Meen
Roh Cheong-Rae
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Abstract
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Objective: We investigated prenatal sonographic characteristics of esophageal atresia (EA) with advancing gestation. We focused on the degree of polyhydramnios and the stomach shape.
Methods: This study included 27 EA cases (EA group) and 81 idiopathic polyhydramnios cases (non-EA group). The non-EA group consisted of cases without any fetal structural anomaly, musculoskeletal disorder, chromosomal abnormality, or maternal diabetes. Both groups included only singleton pregnancies. Amniotic fluid index (AFI) and width/length (W/L) ratio as well as the product of width and length (W×L) of stomach were serially assessed during gestation and compared between the 2 groups. To predict EA using W/L ratio and W×L, receiver operating characteristic curve analysis was performed.
Results: Polyhydramnios was evident in 77.8% of EA cases. We observed 25.9% and 22.2% EA cases with an absent stomach and a small visible stomach, respectively. After 28 weeks, the EA group manifested significantly higher AFI than the non-EA group. After 32 weeks, W/L ratio in the EA group tended to be lower than that in the non-EA group (32-36 weeks: 1.36 vs. 1.72, P=0.092; >36 weeks: 1.43 vs. 1.63, P=0.024). To predict EA, the calculated area under the curve for W/L ratio was 0.651 after 32 weeks. The diagnosis of EA using a cut-off value of W/L ratio <1.376 showed sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio to be 84.6%, 52.9%, 1.796, and 0.081, respectively.
Conclusion: A low W/L ratio of stomach after 32 weeks with progressive idiopathic polyhydramnios may be used to predict EA.
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KEYWORD
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Esophageal atresia, Stomach shape, Polyhydramnios, Ultrasound, Prenatal diagnosis
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