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Liu J, Chen Y, Wang H, Huang D, Du Y, Liu X, Sun X, Yan C, Chen W, Wang H, Zhang R. Novel qualitative and quantitative ultrasound markers to facilitate prenatal diagnosis of congenital duodenal obstruction. J Matern Fetal Neonatal Med 2023; 36:2167072. [PMID: 36726301 DOI: 10.1080/14767058.2023.2167072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Accurate prenatal diagnosis of congenital duodenal obstruction (CDO) is challenging. We aimed to determine new ultrasound metrics for accurate prenatal diagnosis of fetal CDO. METHODS Data pertaining to 46 fetuses with suspected small intestinal obstruction (26 CDO; 16 high jejunal obstructions) were retrospectively analyzed. Prenatal ultrasonographic features including dilated intestinal length, stomach length, maximum intestinal dilatation, ratio of dilated intestinal length at late gestation and dilated stomach length (I/S ratio), and location of distal end of dilated bowel segment relative to spine were compared between CDO and high jejunal obstruction groups. The diagnostic performance of ultrasound indices was evaluated using receiver operating characteristics curve analysis. RESULTS In 25 out of 26 CDO cases, the distal end of the dilated small intestine segment was located on the right side of spine, while that in the high jejunal obstruction group was located on the left side of spine. The dilated intestinal length and I/S ratio in CDO group were significantly smaller than those in high jejunal obstruction group (p < .05). Dilated intestinal length <51 mm or I/S ratio <1 showed high sensitivity (100, 100%) and specificity (96.1, 92.3%) for CDO (area under the curve: 0.995 and 0.988, respectively). There were no significant differences in the AUCs of dilated intestinal length and I/S ratio. Significant correlation of the site of obstruction in CDO with fetal dilated intestinal length and I/S ratio (r = 0.686; 0.660, p < .001, respectively) were noted. CONCLUSION Location of the distal end of the dilated small intestine segment relative to the spine, dilated intestinal length, and I/S ratio may help differentiate fetal CDO from high jejunal obstruction. The latter two metrics were associated with the site of obstruction in CDO patients.
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Affiliation(s)
- Jinrong Liu
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yunyu Chen
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Haiyu Wang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Danping Huang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanyan Du
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaofang Liu
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiuhong Sun
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Can Yan
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenmin Chen
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongying Wang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rui Zhang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Karnul AM, Murthy CK. A Study of Variations of the Stomach in Adults and Growth of the Fetal Stomach. Cureus 2022; 14:e28517. [PMID: 36185902 PMCID: PMC9515405 DOI: 10.7759/cureus.28517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
The stomach is a site for various pathological conditions like congestive hypertrophic pyloric stenosis, peptic ulcer, gastroesophageal reflux disease (GERD), and carcinoma of the stomach. Further, for the treatment of obesity too, surgical manipulation of the stomach is done by a bariatric surgeon. With the availability of a wide range of diagnostic tools like barium meals, USG, CT scan, MRI, and endoscopy, it is possible to identify the variations in the position and shape of the stomach and developmental defects while diagnosing diseases. As thorough knowledge of stomach position and variations will help in preoperative planning and preventing inadvertent damage during surgeries, this topic was taken up for research. Aims and objectives This study aims to study the variations of the stomach in human cadavers and dead fetuses with regard to its length, shape, capacity, ends, curvatures, and mucosal folding and classify them into various groups. In addition, this study also aims to assess the pattern of growth of the stomach in fetuses. Material and methods The stomachs of 50 adult cadavers and 20 dead fetuses were studied by standard dissection method, concerning their topography, shape, level of the cardiac and pyloric orifice, cardiac angle, length of greater (GC) and lesser curvatures (LC), pyloric sphincter, volume, and mucosal folds. Results The stomach was located in the left hypochondriac quadrant in 78% of the samples and in relation to the 7th costal cartilage in 64%. The two main types of classification established were Type I (variation in position along the vertical axis) in 4% and Type II (variation in position along the transverse axis) in 14%. Type III classification comprised the variations in shape, with a J-shaped stomach in 58%, cylindrical in 20%, crescentic in 14%, and reversed L in 8%. The average length showed significant differences in males, 19±2.48 cm vis-a-vis females, 17.1±2.01 cm. In 66% of the cases, the cardiac orifice was to the left of the midline behind the 7th costal cartilage, and the pyloric orifice was to the right, 1.2 cm to the midline and in the transpyloric plane in 76%. The average GC and LC were 33.6±1.43 cm and 27±5.28 cm, respectively. GC was more significant in males. The average length and diameter of the pyloric canal were about 3.56±0.38 cm & 0.77±0.23 cm, respectively. The thickness of the pyloric sphincter did not show a significant gender difference. The average volume was 289.88±69.15 ml. Rugae were normally spaced in 68%, nearly spaced in 18%, and widely spaced in 6%. The fetal stomach measurements were significantly correlated to gestational age and showed linear growth. Conclusion The study of the morphology of the stomach and its variations are important not only to surgeons and anatomists but also to gastroenterologists. The linear growth of the stomach in embryos helps radiologists and obstetricians to diagnose intrauterine growth retardation (IUGR) and congenital anomalies early.
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Liu X, Sun W, Wang J, Chu G, He R, Zhang B, Zhao Y. Prenatal diagnosis of auriculocondylar syndrome with a novel missense variant of GNAI3: a case report. BMC Pregnancy Childbirth 2021; 21:780. [PMID: 34789173 PMCID: PMC8597305 DOI: 10.1186/s12884-021-04238-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Auriculocondylar syndrome (ACS) is a rare disorder characterized by micrognathia, mandibular condyle hypoplasia, and auricular abnormalities. Only 6 pathogenic variants of GNAI3 have been identified associated with ACS so far. Here, we report a case of prenatal genetic diagnosis of ACS carrying a novel GNAI3 variant. CASE PRESENTATION A woman with 30 weeks of gestation was referred to genetic counseling for polyhydramnios and fetal craniofacial anomaly. Severe micrognathia and mandibular hypoplasia were identified on ultrasonography. The mandibular length was 2.4 cm, which was markedly smaller than the 95th percentile. The ears were low-set with no cleft or notching between the lobe and helix. The face was round with prominent cheeks. Whole-exome sequencing identified a novel de novo missense variant of c.140G > A in the GNAI3 gene. This mutation caused an amino acid substitution of p.Ser47Asn in the highly conserved G1 motif, which was predicted to impair the guanine nucleotide-binding function. All ACS cases with GNAI3 mutations were literature reviewed, revealing female-dominated severe cases and right-side-prone deformities. CONCLUSION Severe micrognathia and mandibular hypoplasia accompanied by polyhydramnios are prenatal indicators of ACS. We expanded the mutation spectrum of GNAI3 and summarized clinical features to promote awareness of ACS.
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Affiliation(s)
- Xiaoliang Liu
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Ultrasonography, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jun Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guoming Chu
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Rong He
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bijun Zhang
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanyan Zhao
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, China.
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Kassif E, Weissbach T, Shust‐Barequet S, Raviv O, Snenh SA, Avraham E, Cahan T, Koren N, Yulzari V, Hadi E, Adamo L, Revivo M, Tovi SM, Achiron R, Kivilevitch Z, Weisz B, Weissmann‐Brenner A. The fetal stomach throughout gestation: Normal charts and clinical implication. Prenat Diagn 2021. [DOI: 10.1002/pd.5990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Eran Kassif
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Tal Weissbach
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Shir Shust‐Barequet
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Oshrat Raviv
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Obstetrics and Gynecology Meir Medical Center Kfar Saba Israel
| | - Samar Abu Snenh
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Efrat Avraham
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Obstetrics and Gynecology Meir Medical Center Kfar Saba Israel
| | - Tal Cahan
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Natalie Koren
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
- Department of Obstetrics and Gynecology Meir Medical Center Kfar Saba Israel
| | - Vered Yulzari
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Efrat Hadi
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Laura Adamo
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Department of Obstetrics and Gynecology IRCCS Fondazione Policlinico San Matteo University of Pavia Pavia Italy
| | - Marva Revivo
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Shalev Mazaki Tovi
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Reuven Achiron
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Zvika Kivilevitch
- Women's Ultrasound Unit Maccabi Health Services Negev Medical Center Beer‐Sheva Israel
| | - Boaz Weisz
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Alina Weissmann‐Brenner
- Diagnostic Ultrasound Unit Department of Obstetrics and Gynecology Institute of Obstetrical and Gynecological Imaging Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of Medicine Tel Aviv University Tel Aviv Israel
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Mazzoni G, Alberti D, Torri F, Motta M, Platto C, Franceschetti L, Sartori E E, Signorelli M. Prediction of complex gastroschisis: The evolution of therapeutic techniques and their relation with fetal sonographic features. J Neonatal Perinatal Med 2021; 15:137-145. [PMID: 34334428 DOI: 10.3233/npm-210746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To analyze prenatal ultrasound (US) markers to predict treatment and adverse neonatal outcome in fetal gastroschisis. METHODS It was conducted a retrospective single-center study considering all pregnancies with isolated gastroschisis that were treated in our department between 2008 and 2020. 17 US markers were analyzed. Moreover, the association between prenatal ultrasound signs and neonatal outcomes was analyzed: need of bowel resection, techniques of reduction, type of closure, adverse neonatal outcomes, time to full enteral feeding, length of total parenteral nutrition and length of hospitalization. RESULTS The analysis included 21 cases. We found significant associations between intestinal dilation (≥10 mm) appeared before 30 weeks of gestation and the need of bowel resection (p = 0.001), the length of total parenteral nutrition (p = 0,0013) and the length of hospitalization (p = 0,0017). Intrauterine growth restriction (IUGR) is a risk factor for serial reduction (p = 0,035). There were no signs significantly associated with the type of closure. Hyperbilirubinemia is related with gestational age (GA) at the diagnosis of intra-abdominal bowel dilation (IABD) (p = 0.0376) and maximum IABD (p = 0.05). All newborns with sepsis had echogenic loops in uterus (p = 0.026). The relation between the GA at delivery and the GA at the extra-abdominal bowel dilation (EABD)≥10 mm was r = 0.70. CONCLUSION We showed the significant role of the early presence of bowel dilation in predicting intestinal resection and adverse outcomes. All IUGR fetuses needed staged reduction through the silo-bag technique. The echogenic bowel was related to neonatal sepsis, while IABD was associated with hyperbilirubinemia.
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Affiliation(s)
- G Mazzoni
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - D Alberti
- Department of Pediatric Surgery, Spedali Civili Children's Hospital of Brescia, Brescia BS, Italy
| | - F Torri
- Department of Pediatric Surgery, Spedali Civili Children's Hospital of Brescia, Brescia BS, Italy
| | - M Motta
- Department of Neonatology, University of Brescia, Brescia BS, Italy
| | - C Platto
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - L Franceschetti
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - E Sartori E
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
| | - M Signorelli
- Department of Obstetrics and Gynecology, University of Brescia, Brescia BS, Italy
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Townsel C, Stone J, Debolt C, Hussain N, Campbell WA. Fetal gastric area ratio to predict severe neonatal opioid withdrawal syndrome. J Matern Fetal Neonatal Med 2021; 35:7957-7961. [PMID: 34151686 DOI: 10.1080/14767058.2021.1939302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Neonatal opioid withdrawal syndrome (NOWS) can occur in newborns exposed to opioids in pregnancy. Opioids delay gastric emptying and inhibit gastric motility in adults, but little is known about their effect in the fetus. We sought to assess gastric area ratio (GAR) in opioid-exposed fetuses. STUDY DESIGN Retrospective cohort study including opioid-exposed maternal-neonatal dyads between 2007-2017. Primary outcome: severe NOWS (three consecutive Finnegan scores ≥8 or three scores totaling ≥24 within 96 h of life). GAR: (gastric area)/(transverse abdominal area) × 100. Data analysis was by descriptive, parametric, and non-parametric tests. RESULTS Forty-nine maternal-neonatal dyads were included, 67% (n = 33) with severe NOWS. GAR <95th percentile for gestational age was seen in 80% of neonates (n = 39). However, GAR was not different between groups (p = .90) and did not predict severe NOWS. CONCLUSION Fetal GAR was <95th percentile in 80% of opioid-exposed neonates. However, fetal GAR may not predict NOWS treatment.
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Affiliation(s)
- Courtney Townsel
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Julie Stone
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA
| | - Chelsea Debolt
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Naveed Hussain
- Department of Pediatrics, Division of Neonatology, Connecticut Children's Hospital, Farmington, CT, USA
| | - Winston A Campbell
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Connecticut, Farmington, CT, USA
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Toscano M, Burhans K, Mack LM, Henderson S, Koltz PF, Girotto JA, Thornburg LL. Prenatal Ultrasound Measurement of Fetal Stomach Size Is Predictive of Postnatal Development of GERD in Isolated Cleft Lip and/or Palate. Cleft Palate Craniofac J 2020; 58:881-887. [PMID: 33153316 DOI: 10.1177/1055665620968717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether prenatal ultrasound measurement of fetal stomach size, as a surrogate marker of fetal swallowing, is predictive of postnatal development of gastroesophageal reflux disease (GERD) in cases of isolated cleft lip and/or palate (CL/P). DESIGN This is a retrospective case-control study. The outcome of interest is postnatal diagnosis of GERD in isolated CL/P. The exposure of interest is prenatal stomach size measurement by ultrasound. SETTING The study population was selected from an academic, tertiary care center between 2003 and 2011. PATIENTS/PARTICIPANTS Cases were neonates undergoing CL/P repair during the study period. Cases with other known structural or chromosomal abnormalities were excluded. Controls were contemporary, nondiabetic neonates that matched gestational age (within one week) to cases. Each case measurement was matched ∼1:2 with control measurement. INTERVENTIONS None. MAIN OUTCOME MEASURE The primary outcome was difference in mean prenatal ultrasound measurement of fetal stomach size between cases and controls. We hypothesized that patients with postnatal development of GERD would have smaller mean fetal stomach size. RESULTS There were 32 cases including 19 patients with unilateral cleft lip and palate, 8 with unilateral cleft lip, and 4 with bilateral cleft lip and palate. Cases were noted to have smaller mean anterior-posterior and transverse fetal stomach measurements as compared to controls. This was statistically significant from 16 to 21 weeks, 25 to 27 weeks, and 28 to 36 weeks (P < .01 for all). CONCLUSIONS Prenatal ultrasound measurement of fetal stomach size as a surrogate marker of fetal swallowing is predictive of postnatal development of GERD in isolated CL/P.
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Affiliation(s)
- Marika Toscano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Kristen Burhans
- Department of Obstetrics and Gynecology, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Lauren M Mack
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 3989Baylor College of Medicine, Houston, TX, USA
| | | | - Peter F Koltz
- St. Luke's Hospital, Maumee, Ohio, USA.,St. Anne's Hospital, Toledo, Ohio, USA
| | - John A Girotto
- Spectrum Health Medical Group, Grand Rapids, MI, USA.,24319Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Loralei L Thornburg
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 6923University of Rochester Medical Center, Rochester, NY, USA
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McCormick BM, Blakemore KJ, Johnson CT, Bishop JC, Jelin EB, Miklos JM, Jelin AC. Outcomes of both complex and isolated cases of infants with large stomach on fetal ultrasound. Am J Obstet Gynecol MFM 2020; 3:100272. [PMID: 33451621 DOI: 10.1016/j.ajogmf.2020.100272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND A sonographically large fetal stomach has been associated with gastrointestinal obstruction, per case reports, and is often followed up with serial ultrasound examinations. The frequency of this phenomenon has not been systematically studied, resulting in challenges in counseling parents about the prognosis and making cost-benefit analysis of serial ultrasound follow-up difficult to assess. OBJECTIVE This study aimed to determine the frequency at which an enlarged fetal stomach as the sole abnormality on fetal ultrasound reflects a bowel obstruction to aid in parental counseling and determine the best practice for follow-up. STUDY DESIGN We performed a retrospective cohort study of all prenatal sonographic cases in which a large fetal stomach was visualized between January 1, 2002, and June 1, 2016. The inclusion criteria required a fetal diagnosis of a large stomach, defined as an increased measurement in ≥2 dimensions based on a nomogram, that resulted in a liveborn delivery within the Johns Hopkins Health System. We excluded pregnancy loss, pregnancy termination, and cases delivered outside of the Johns Hopkins Health System. Cases were subclassified as isolated or complex based on the absence or presence of additional ultrasound findings at initial presentation of the enlarged stomach. The perinatal outcomes and maternal demographics were determined and compared between isolated and complex cases. RESULTS Of 57,346 total cases with ultrasound examinations in the Johns Hopkins Health System within the study time frame, 348 fetuses had enlarged stomachs, with 241 (69.3%) who met the inclusion criteria as follows: 161 (66.8%) isolated and 80 (33.2%) complex. Of the 161 isolated cases, 1 resulted in neonatal small bowel obstruction (0.62%). Of note, 158 of the isolated large stomach cases (98.1%) had no postnatal abnormalities of any kind. Of the 80 complex cases, 18 (22.5%) resulted in neonatal gastrointestinal obstruction (14 cases of duodenal atresia and 4 cases of jejunal atresia). Those with isolated findings were significantly less likely to deliver preterm (n=24 [14.9%] vs n=35 [43.8%]; P<.001), be complicated by polyhydramnios (n=18 [11.2%] vs n=23 [28.8%]; P<.001), have a neonatal intensive care unit admission (n=31 [19.3%] vs n=76 [95.0%]; P<.01), or have a major surgical procedure (n=2 [1.2%] vs n=66 [82.5]; P<.001) compared with complex cases. CONCLUSION We found that 0.62% of isolated large fetal stomachs (1 of 161) were associated with neonatal intestinal obstruction. Of the complex cases with an enlarged stomach, 18 of 80 (22.5%) were found to have a gastrointestinal obstruction; by definition, none of these complex cases began as an isolated large stomach as their initial ultrasound finding, but rather had other concurrent sonographic abnormalities, including a double bubble sign and intestinal dilation. With a prevalence of <1% resulting in the development of a small bowel obstruction, our results suggest that, when isolated, a large stomach does not seem to warrant serial prenatal ultrasound follow-up or postnatal imaging and is likely to reflect an incidental finding.
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Affiliation(s)
| | - Karin J Blakemore
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clark T Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Anne Arundel Medical Center, Annapolis, MD
| | - Juliet C Bishop
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric B Jelin
- Division of Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeanne M Miklos
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Angie C Jelin
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD
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Hata T, Tanaka H, Noguchi J, Inubashiri E, Yanagihara T, Kondoh S. Three-dimensional sonographic volume measurement of the fetal stomach. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1808-1812. [PMID: 20888688 DOI: 10.1016/j.ultrasmedbio.2010.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 06/08/2010] [Accepted: 06/17/2010] [Indexed: 05/29/2023]
Abstract
The objective of this study was to measure the fetal gastric volume using three-dimensional (3-D) ultrasound during pregnancy. Three-dimensional sonographic examinations were performed involving 35 pregnant women from 12 to 38 weeks of gestation. The fetal gastric volume was monitored every 5 min for a minimum of 40 min (40-60 min) in each woman. The rotational technique with Virtual Organ Computer-aided AnaLysis (VOCAL) was used to calculate the fetal gastric volume. Maximum and minimum gastric volumes were curvilinearly associated with the gestational age, respectively (R(2) = 0.611, p < 0.0001, and R(2) = 0.407, p < 0.0001, respectively). A curvilinear relationship was noted between the functional capacity (maximum volume - minimum volume) of the fetal stomach and gestational age (R(2) = 0.531, p < 0.0001). The maximum volume change [(maximum volume - minimum volume/maximum volume) × 100] did not change during pregnancy (mean and standard deviation, 64.1% ± 16.1%). However, gastric emptying cycles could not be determined in this study because of the short observation period and small number of subjects. Our findings suggest that the fetal gastric volume calculated by conventional two-dimensional ultrasound in previous investigations is approximately one-third of the maximum volume using 3-D ultrasound in the present study and that 3-D ultrasound is a superior means of evaluating the fetal gastric volume in utero. However, the data and their interpretation in the present study should be viewed with some degree of caution because of the small number of subjects. Further studies involving a larger sample size are needed to confirm these findings.
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Affiliation(s)
- Toshiyuki Hata
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, Miki, Kagawa, Japan.
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Koyuncu E, Malas MA, Albay S, Cankara N, Karahan N. The development of fetal pylorus during the fetal period. Surg Radiol Anat 2008; 31:335-41. [DOI: 10.1007/s00276-008-0449-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 11/26/2008] [Indexed: 10/21/2022]
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Blaas HGK, Eik-Nes SH. Sonographic development of the normal foetal thorax and abdomen across gestation. Prenat Diagn 2008; 28:568-80. [DOI: 10.1002/pd.1963] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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