Outcomes of Both Complex and Isolated Cases of Infants With Large Stomach on Fetal Ultrasound [33D

Abstract

INTRODUCTION: A sonographically large fetal stomach has resulted in gastrointestinal obstruction, per case reports, and is often followed with serial ultrasounds. We hypothesize that a LS is predictive of neonatal bowel obstruction. METHODS: We performed retrospective cohort study of all prenatal sonographic cases with a large stomach visualized between 1/1/02-6/1/16. Inclusion criteria required a liveborn delivery within the Johns Hopkins health system. We excluded pregnancy loss/termination cases and cases delivered outside JHHS. We defined a large stomach as an increased measurement in 2 or greater dimensions based on a normogram. Cases were classified as isolated or complex based on additional US findings at initial presentation. We collected demographics, sonographic findings and postnatal outcomes. Approval was obtained by the Johns Hopkins IRB. RESULTS: We identified 340 fetuses with large stomach. Two hundred thirty three met inclusion criteria, including 160 isolated and 73 complex. Of the 160 isolated cases, none resulted in gastrointestinal obstruction. Those with isolated findings were significantly less likely to deliver preterm (n=24, 15.0% vs n=31, 42.5%, p<0.001). Isolated cases were less likely to be complicated by polyhydramnios (n=13, 8.1% vs. n=18, 24.7%, p<0.001), NICU admittance (n=30, 18.8% vs n=70, 95.9%, P<0.001) or neonatal procedure (n=1, 0.63% vs. n=60, 82.2, p<0.001). CONCLUSION: While a sonographically large fetal stomach has been reported to result in gastrointestinal obstruction, the rate may be lower than previously hypothesized. We found that <1% of large fetal stomachs resulted in obstruction. When isolated, a large stomach is not a sole indication for ultrasounds and postnatal imaging.