Esophageal atresia and tracheoesophageal fistula: prenatal sonographic Manifestation from early to late pregnancy.

OBJECTIVE: Esophageal atresia with or without trachea-esophageal fistula (EA/TEF) remains one of the most prenatally missed congenital anomalies. The aim of our study was to elucidate sonographic manifestation of EA/TEF throughout pregnancy. METHODS: A retrospective study of 12 years was performed at a tertiary center. The prenatal ultrasound scans of 75 newborns with EA/TEF were assessed for rate and timing of detection of three principle signs: 1) small/absent stomach and/or 2) worsening polyhydramnios; both considered as 'suspected'; and 3) esophageal pouch which was considered as 'detected'. We assessed the yield of the early, mid-trimester and third trimester anomaly scans to the prenatal diagnosis of EA/TEF. RESULTS: A small/absent stomach was detected on the early anomaly scan in 3.6% of patients scanned, without definitive diagnosis. The mid-trimester scan suspected 19% and detected 4.5% of scanned cases. The third trimester anomaly scan suspected 44% and detected 36.4% of scanned cases. In total, 44% of our cohort were suspected for EA/TEF ,33.3% were prenatally detected and 10.7% were suspected but, eventually, not detected. CONCLUSION: Prenatal diagnosis of EA/TEF is not feasible in early pregnancy. A small/absent stomach may be visualized as early as 15 weeks of gestation. Polyhydramnios does not develop before mid-trimester. An esophageal pouch can be detected as early as 22 weeks, on a targeted scan, in suspected cases. The detection rate of all 3 signs increases with advancing pregnancy, peaking at the third trimester. The early and mid-trimester anomaly scans perform poorly as a screening and diagnostic exam for EA/TEF. This article is protected by copyright. All rights reserved.