PREGNANCY OUTCOMES FOLLOWING SONOGRAPHIC NONVISUALIZATION OF THE FETAL STOMACH

Objective: To review pregnancy outcomes when two or more ultrasound sc ans persistently fail to visualize the fetal stomach. Methods: A compu terized ultrasound database was used to identify all fetuses in which two or more serial ultrasound examinations failed to visualize the fet al stomach. Sonographic images were reviewed retrospectively, with the reviewer blinded to outcome data, to confirm persistent nonvisualizat ion. Pregnancy outcome data were obtained from hospital charts and phy sicians' office records. Fetal karyotypes, when performed, were obtain ed from amniotic fluid (AF) culture. The ultrasound findings then were compared with fetal karyotype results and pregnancy outcome data. Res ults: Of 35,569 ultrasound scans performed during 1991-1996, 26 fetuse s (0.07%) with persistently nonvisualized stomachs were identified. St ructural defects were detected in 17 fetuses (65%), most often involvi ng the cardiothoracic (n = 5), genitourinary (n = 4), and central nerv ous systems (n = 4). Karyotypes were obtained in 12 fetuses, and four of them were abnormal. Only five of 17 fetuses (29%) with a structural defect survived. In nine of 26 fetuses (35%) with persistently nonvis ualized stomachs, no structural defect was identified. Each of these n ine fetuses had abnormal AF volume in its surrounding sac, and the ove rall perinatal survival in fetuses without a structural defect was onl y 50%. Conclusion: Fetuses with persistently nonvisualized stomachs ha ve an increased incidence of structural defects and AF abnormalities a nd are more likely to have a poor outcome. A detailed ultrasound exami nation and fetal karyotype analysis should be performed to evaluate fe tuses with persistently nonvisualized stomachs. (C) 1998 by The Americ an College of Obstetricians and Gynecologists.