Oesophageal atresia and other disorders with a similar antenatal presentation

Abstract

Oesophageal atresia without distal tracheo-oesophageal fistula is a recognized cause of the absence of fluid in the fetal stomach seen on serial ultrasound examinations. It is rare not to demonstrate fluid in the fetal stomach after 15 weeks gestation. There have been several reports of the antenatal diagnosis of oesophageal atresia by ultrasound, the earliest by Farrant (1980). Oesophageal atresia occurs once in every 1500 live births and 90% of these are associated with a tracheooesophageal fistula. The fistula is usually to the distal oesophageal segment but rarely are a distal and proximal fistula found. In 1%, an H-type tracheooesophageal fistula is present without an associated oesophageal atresia. In cases of oesophageal atresia with tracheo-oesophageal fistula to the distal segment, fluid in the lungs and major airways may reach the fetal stomach by way of the fistula in spite of oesophageal interruption. Polyhydramnios may still be present. When oesophageal atresia occurs in isolation (10%) or when a single fistula is present to the proximal oesophagus (1%), no fluid can enter the stomach and none will be seen on serial ultrasound examinations. The purpose of this report is to review other abnormalities that may produce a similar appearance and to document two cases presenting in this manner, which, to our knowledge, have not been previously reported. A 31-year-old gravida 5 para 3 in her 32nd week of gestation was examined to assess the placental position. A live fetus was present in the vertex position. Mild polyhydramnios was present.