Persistent non-visualisation of the fetal stomach: diagnostic and prognostic implications

All fetuses diagnosed with 'absent stomach' at anomaly screening over an 8-year period were identified using the University College Hospital fetal medicine database. These were cross-referenced with records from the paediatric surgical unit at Great Ormond Street Hospital and pathology department at University College Hospital to ascertain postnatal or postmortem diagnosis and outcome in each case.

Of the 84 cases identified, eight were found to have normal stomachs on subsequent antenatal scans, while 76 had persistent non-visualisation of the stomach. Underlying diagnoses included 24 gastro-intestinal tract and/or respiratory anomalies, 22 aneuploidies, six neuromuscular syndromes, three central nervous system anomalies, seven renal anomalies and five genetic syndromes. Seven cases had no identifiable postnatal abnormalities, 26 pregnancies were terminated and nine fetuses died in utero. Of the 33 live births, eight died in the neonatal period and three died in infancy. Only 28 survived into childhood. Two patients were lost to follow up.

Persistent non-visualisation of the fetal stomach in the antenatal period was associated with a wide range of underlying diagnoses. In many cases, prognosis was poor. Only 37% of pregnancies resulted in liveborn infants surviving more than 6 months. The incidence of an abnormal karyotype was 29%. Diagnosis and outcome was normal in only 9.2% of cases. We propose an algorithm for the management of persistent non-visualisation of the fetal stomach on antenatal ultrasound.