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Geburtshilfe Frauenheilkd 2015; 75(11): 1148-1152
DOI: 10.1055/s-0035-1558172
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Measurement of Gastric Circumference in Foetuses with Oesophageal Atresia

Messung des Magenumfangs bei Feten mit Ösophagusatresie
M. Hoopmann
1   Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
,
K. O. Kagan
1   Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
,
F. Borgmeier
1   Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
,
G. Seitz
2   Department of Pediatric Surgery and Urology, University Childrenʼs Hospital, Tübingen
,
J. Arand
3   Department of Neonatology, University Childrenʼs Hospital, Tübingen
,
P. Wagner
1   Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
› Author Affiliations
Further Information

Publication History

received 18 July 2015
revised 23 August 2015

accepted 25 August 2015

Publication Date:
14 December 2015 (online)

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Abstract

Background: The specific recognition of oesophageal atresia (OA) with or without a tracheal fistula in a foetus is a diagnostic challenge for prenatal medicine. The aim of the present work is to analyse the value of the measurement of gastric size in the diagnosis of this significant malformation. Materials and Methods: Altogether, the examinations of 433 pregnancies between the 18.4 and 39.1 weeks of gestation were retrospectively analysed. 59 of these foetuses exhibited an OA. By means of a linear regression analysis with normal foetuses, significant parameters influencing gastric size were examined. Subsequently the gastric sizes were transformed into z values and a comparison was made between OA with and without fistulae with the help of t tests. Results: In the normal foetuses there was a significant association between the gastric circumference and the abdominal circumference (circumference = 6.809 + 0.179 × abdominal circumference, r = 0.686, p < 0.0001). In the normal group the average was 43.0 (standard deviation [SD] 13.7) mm and those in foetuses with and without fistuale were 33.8 (SD 22.7) and 0.9 (SD 3.7) mm. In 34 (57.6 %) foetuses with an OA, the gastric circumference was below the 5th percentile. In detail, there were 13 (34.2 %) foetuses with a fistula and 21 (100 %) without a fistula. The average z values in the normal group and in the groups of OA with fistula and without fistula amounted to 0.0 (SD 1.0), −1.3 (SD 2.2) and −4.5 (SD 1.0). Conclusion: Measurements of the gastric circumference below the 5th percentile should lead to further diagnostic measures, especially when associated with polyhydramnios. Although OA without a fistula is always conspicuous, only about one in three OAs with fistula are associated with a significantly smaller stomach.

Zusammenfassung

Fragestellung: Die gezielte Erkennung einer fetalen Ösophagusatresie (ÖA) mit oder ohne tracheale Fisteln stellt eine diagnostische Herausforderung für die Pränatalmedizin dar. Ziel der vorliegenden Arbeit war es, den Stellenwert der Messung des Magenumfangs für die Diagnostik dieser bedeutsamen Fehlbildung zu analysieren. Material und Methodik: Insgesamt wurden die Untersuchungen von 433 Schwangerschaften zwischen der 18,4 bis 39,1 Schwangerschaftswoche retrospektiv ausgewertet. 59 dieser Feten wiesen eine ÖA auf. Mittels linearer Regressionsanalyse wurden bei normalen Feten signifikante Einflussparameter auf den Magenumfang untersucht. Anschließend erfolgte die Umwandlung der Magenumfänge in z-Werte und der Vergleich zwischen den ÖA mit und ohne Fistel mit der Normalpopulation mithilfe eines t-Tests. Ergebnisse: Bei den normalen Feten zeigte sich eine signifikante Assoziation zwischen dem Umfang des Magens und dem Abdomenumfang (Umfang = 6,809 + 0,179 × Abdomenumfang, r = 0,686, p < 0,0001). Der mittlere Magenumfang lag in der normalen Gruppe bei 43,0 (Standardabweichung [STW] 13,7) mm und bei Feten mit und ohne Fistel bei 33,8 (STW 22,7) und 0,9 (STW 3,7) mm. Bei 34 (57,6 %) Feten mit einer ÖA lag der Magenumfang < 5er-Perzentile. Im Einzelnen waren es 13 (34,2 %) Feten mit einer Fistel und 21 (100 %) ohne Fistel. Die mittleren z-Werte in der normalen Gruppe und in der Gruppe der ÖA mit Fistel und ohne Fistel lagen bei 0,0 (STW 1,0), −1,3 (STW 2,2) und −4,5 (STW 1,0). Schlussfolgerung: Messungen des Magenumfangs < 5er-Perzentile sollten eine weiterführende Diagnostik nach sich ziehen. Während ÖA ohne Fisteln hierbei stets auffällig werden, weist nur ungefähr jede 3. ÖA mit Fistel einen signifikant verkleinerten Magen auf.

Key words

gastric circumference - oesophageal atresia - tracheo-oesophageal fistula

Schlüsselwörter

Magenumfang - Ösophagusatresie - tracheoösophageale Fistel

Supporting Information

 

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