Millener P B, Anderson N G, Chisholm R J
Department of Radiology, Christchurch Hospital, Christchurch, New Zealand.
AJR Am J Roentgenol. 1993 Apr;160(4):827-30. doi: 10.2214/ajr.160.4.8456673.
To establish the prognostic significance of nonvisualization of the fetal stomach, we prospectively studied the course and outcome of 31 pregnancies in which a normal fluid-filled fetal stomach could not be seen during sonographic examination after 14 weeks' gestation.
Between April 1989 and May 1991, 7200 sonographic examinations of fetuses after 14 weeks' gestation were done at our hospital. In 31 pregnancies (0.4% of all scans), a normal fluid-filled fetal stomach could not be seen on one or more sonograms after 14 weeks' gestation (range, 14-40 weeks; mean, 22 weeks). The following data were recorded for each examination: gestational age, visualization of the stomach, other fetal abnormalities, and volume of amniotic fluid. In each pregnancy, the average number of sonograms obtained was three (range, one-five). The fetal stomach was regarded as abnormal if the stomach bubble was absent or remained very small and unchanged for at least 45 min during sonography.
The outcome was normal in 16 cases. The 15 abnormal outcomes included spontaneous fetal or neonatal death in five, pregnancy terminations in three, and persistent postnatal disability in seven. In 15 pregnancies (48%) lack of visualization of the fetal stomach was the only significant abnormal sonographic finding, but an abnormal outcome occurred in three. In 12 pregnancies, nonvisualization of the fetal stomach was a transient finding, yet three of those pregnancies resulted in persistent postnatal disability, and one was terminated because of severe maternal preeclampsia. A normal fluid-filled stomach was seen on the next sonogram in 15 cases, but five had an abnormal outcome. Only one of the four pregnancies in which a normal stomach was not seen on any subsequent sonogram had an abnormal outcome. Six of seven pregnancies with oligohydramnios had an abnormal outcome, and all three cases with polyhydramnios had an abnormal outcome. The prevalence of abnormal outcome was 88% when additional sonographic abnormalities were observed, but 20% when no other sonographic abnormality was seen. The overall prevalence of abnormal outcome when the fetal stomach was not visualized was 48%.
Not all fetuses with a nonvisualized stomach after 19 weeks' gestation have a poor outcome. Not all fetuses with a transiently nonvisualized stomach have a normal outcome.
为确定胎儿胃泡未显示的预后意义，我们前瞻性地研究了31例妊娠的过程及结局，这些妊娠在孕14周后超声检查时未见到正常的充盈液体的胎儿胃泡。
1989年4月至1991年5月，我院对孕14周后的胎儿进行了7200次超声检查。在31例妊娠（占所有扫描的0.4%）中，孕14周后（范围为14 - 40周，平均22周）的一次或多次超声检查未见到正常的充盈液体的胎儿胃泡。每次检查记录以下数据：孕周、胃泡显示情况、其他胎儿异常及羊水量。每一妊娠获得的超声检查平均次数为3次（范围为1 - 5次）。超声检查时若胃泡缺如或至少45分钟内一直很小且无变化，则胎儿胃被视为异常。
16例结局正常。15例异常结局包括5例胎儿或新生儿自然死亡、3例终止妊娠以及7例出生后持续残疾。在15例妊娠（48%）中，胎儿胃泡未显示是唯一显著的超声异常发现，但其中3例结局异常。在12例妊娠中，胎儿胃泡未显示是一过性表现，然而其中3例妊娠导致出生后持续残疾，1例因严重的母亲先兆子痫而终止妊娠。15例在下一次超声检查时见到了正常的充盈液体的胃泡，但5例结局异常。在随后任何超声检查均未见到正常胃泡的4例妊娠中，仅1例结局异常。7例羊水过少的妊娠中有6例结局异常，所有3例羊水过多的病例结局均异常。观察到其他超声异常时异常结局的发生率为88%，未见到其他超声异常时为20%。胎儿胃泡未显示时异常结局的总体发生率为48%。
并非所有孕19周后胃泡未显示的胎儿结局都差。并非所有胃泡一过性未显示的胎儿结局都正常。
