Abstract This study aimed to analyse and determine the prenatal detection rate of sonographic manifestations of fetuses with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF), by identifying prenatal sonographic features such as a small or absent stomach bubble, with or without polyhydramnios, and the esophageal pouch sign. This was a retrospective study of prenatal sonographic findings of neonates who were diagnosed with congenital EA with or without TEF postnatally, and treated at Fernandez Hospital, Hyderabad, born between 2006 and 2024, over a period of 19 years. Their corresponding prenatal sonographic evaluation and care were at the Fetal Medicine Unit of Fernandez Hospital. A total of 33 neonates were born with congenital EA with TEF over the period of 19 years, between 2006 and 2024. One mother in this cohort did not undergo any prenatal ultrasounds or prenatal care, hence was only included in demographic and perinatal/postnatal analysis. Thirty-two cases, therefore, were included in the prenatal sonographic evaluation. All cases suspected prenatally of esophageal atresia/tracheoesophageal fistula (EA/TEF) revealed polyhydramnios with absent/small stomach bubbles, typically. However, another 22% of cases with polyhydramnios were only diagnosed with EA/TEF postnatally, whereas 22% of cases diagnosed postnatally demonstrated normal liquor volume. Two cases, which were diagnosed prenatally, revealed absent stomach bubbles, polyhydramnios, as well as esophageal pouches, which were evident only at later gestation, in the third trimester. 43.8% of fetuses with stomach bubbles detected on their prenatal ultrasounds revealed EA/TEF diagnosis postnatally. Overall, in our cohort, 48.5% cases were suspected prenatally of EA/TEF, but the remaining 45.4% were diagnosed postnatally. Two (6.1%) cases were diagnosed prenatally, consistent with the detection of esophageal pouches. There was no significant difference noted in perinatal/postnatal outcomes between those suspected prenatally and those diagnosed postnatally of EA/TEF. One neonate had Gross type E (TEF without EA), whereas the remaining 32 neonates were diagnosed with Gross type C (EA with distal TEF). Prenatal diagnosis of EA with or without TEF is indeed challenging. The indirect sonographic signs, typically an absent or small stomach bubble, polyhydramnios, and/or an esophageal pouch, seem to be more apparent with advancing gestation, especially in the third trimester. However, ultrasound performs poorly as a screening or diagnostic modality for fetal EA/TEF. Nevertheless, prenatal detection is useful to facilitate prenatal counselling of families and plan appropriate perinatal and postnatal care of the baby, as this is a neonatal emergency condition, whereby early neonatal surgical intervention may be indicated.
Raju et al. (Fri,) studied this question.