Second trimester prenatal diagnosis of congenital gastric outlet obstruction.

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Prenatal diagnosis of gastric outlet obstruction is made infrequently owing to variations in gastric dimension, and reports from the literature have been confined to diagnosis in the third trimester.We report a case of second trimester diagnosis of congenital pyloric atresia.Early diagnosis during pregnancy may be valuable in facilitating both prenatal and postnatal management. CASE REPORTA 34 year old woman was referred in preterm labor at 24 weeks 2 days of gestation.Her first pregnancy had been complicated by idiopathic preterm labor, culminating in the delivery of a healthy 1.9 kg male infant at 30 weeks' gestation.The present pregnancy had been uncomplicated, with confirmation of menstrual dates by ultrasonographic estimation at 16 weeks.The fetal anatomy at that time was noted to be normal.A genetic amniocentesis also was performed and revealed a normal male karyotype.When she first was examined no clinically obvious hydramnios was noted.The cervix was 2 cm dilated and 50% effaced, with bulging membranes.A random blood glucose determination was normal and the maternal blood group was O negative with anti-Leb antibodies present.Ultrasonographic examination confirmed an increase in amniotic fluid volume, with the deepest vertical pocket measuring 98 mm.The fetal stomach was dilated (Fig. 1), with a measurement in the longitudinal axis of 33 mm, which was well above the normal range. 1 No other abnormalities were seen and fetal growth was otherwise appropriate for gestational age.The patient was managed conservatively with tocolysis and bed rest.During the course of the next 3 weeks, serial measurements of the longitudinal axis of the stomach varied between 21 and 40 mm (Fig. 2).The combination of gastric dilation and polyhydramnios suggested the diagnosis of gastric outlet obstruction.We consulted with surgical and neonatal specialist colleagues as appropriate.Labor supervened at 27 weeks of gestation.The patient had a sudden spontaneous rupture of membranes, and the cervix was found to be fully dilated.A live male infant weighing 860 g was delivered vaginally as a breech birth.He was electively intubated and ventilated.A plain abdominal radiograph revealed a dilated stomach with no air distally (Fig. 3).Contrast studies from above and below confirmed that atresia was present only at the level of the stomach (Fig. 4).At laparotomy the day after delivery, no external abnormality of the duodenum or stomach was noted, but a nasogastric tube could not be passed beyond the pylorus.