Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College Hospital, London, UK.
Arch Dis Child Fetal Neonatal Ed. 2010 Nov;95(6):F439-42. doi: 10.1136/adc.2009.179341. Epub 2010 Jun 10.
All fetuses diagnosed with 'absent stomach' at anomaly screening over an 8-year period were identified using the University College Hospital fetal medicine database. These were cross-referenced with records from the paediatric surgical unit at Great Ormond Street Hospital and pathology department at University College Hospital to ascertain postnatal or postmortem diagnosis and outcome in each case.
Of the 84 cases identified, eight were found to have normal stomachs on subsequent antenatal scans, while 76 had persistent non-visualisation of the stomach. Underlying diagnoses included 24 gastro-intestinal tract and/or respiratory anomalies, 22 aneuploidies, six neuromuscular syndromes, three central nervous system anomalies, seven renal anomalies and five genetic syndromes. Seven cases had no identifiable postnatal abnormalities, 26 pregnancies were terminated and nine fetuses died in utero. Of the 33 live births, eight died in the neonatal period and three died in infancy. Only 28 survived into childhood. Two patients were lost to follow up.
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.
在 8 年的时间里，通过使用伦敦大学学院附属医院胎儿医学数据库，所有在异常筛查中被诊断为“胃缺失”的胎儿都被识别出来。这些病例与大奥蒙德街儿童医院小儿外科病房和伦敦大学学院附属医院病理科的记录进行交叉核对，以确定每例病例的产后或死后诊断和结果。
在所确定的 84 例病例中，有 8 例在随后的产前扫描中发现胃正常，而有 76 例胃仍未被可视化。潜在的诊断包括 24 例胃肠道和/或呼吸道异常、22 例非整倍体、6 例神经肌肉综合征、3 例中枢神经系统异常、7 例肾脏异常和 5 例遗传综合征。7 例病例无明确的产后异常，26 例妊娠终止，9 例胎儿宫内死亡。在 33 例活产中，有 8 例新生儿期死亡，3 例婴儿期死亡。只有 28 例存活到儿童期。有 2 例患者失访。
在产前时期胎儿胃未被可视化与广泛的潜在诊断相关。在许多情况下，预后较差。只有 37%的妊娠导致活产婴儿存活超过 6 个月。异常核型的发生率为 29%。只有 9.2%的病例诊断和结果正常。我们提出了一种用于管理产前超声持续性胃未可视化的算法。
