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Small Stomach or Failure to Detect the Stomach on Ultrasonography

The stomach, like any fluid cavity, can be clearly observed on ultrasound examination. Sometimes it can appear to be small, but on further examination at a later stage it will appear normal. However, if repeated ultrasound examinations consistently show a small stomach, other problems must be considered. The main signs that should be checked for are those that are indicative of congenital atresia (blockage) of the esophagus (gullet), and failure of the amniotic fluid to pass into the stomach after swallowing, which is a normal fetal action. It is also necessary to look for defects in the intestinal structure, changes in the amount of amniotic fluid, etc.

Three studies reported in the literature have found an increased statistical risk for Down syndrome in cases of a small stomach - some cite a threefold greater risk compared to women whose fetuses do not have this finding. However, other studies have not demonstrated a significant increase in the risk for Down syndrome in such cases.

What action is recommended when a small stomach is found?

A repeat ultrasound examination should be performed the day after the small stomach was first discovered.

If the finding is confirmed and the stomach still appears small, then an ultrasound examination directed mainly at the intestines should be carried out to check for polyhydramnios (excessive amniotic fluid) and other defects.

There are differing opinions regarding testing amniotic fluid when a small stomach is confirmed on repeat ultrasound examination.

Amniocentesis (and chorionic villus sampling) is undoubtedly the only test that can categorically rule out chromosomal disorders.
However, it is neither medically indicated nor recommended that every pregnant woman should undergo amniocentesis - only those who are at high risk of having a specific problem that can be examined by this test (see information sheet titled: Why is there no medical recommendation for amniocentesis in all cases?).

Most opinions hold that in the majority of the cases where a small stomach is the only abnormal finding, and taking into account the other parameters stated above when these do not increase the risk for a chromosome disorder, the weighted risk is not in the high-risk range at which amniocentesis is recommended. However, it should be noted that there are no accurate statistical data that allow for a precise calculation of the weighted risk taking into account all the findings.

For practical purposes:

Some physicians recommend amniocentesis more readily in cases where the fetus has a small stomach - the borderline for recommendation based on the risk for Down syndrome is increased from 1:386 to 1:1000. If other abnormal findings are also present, these guidelines are insufficient and the woman should be referred for genetic counseling. In genetic counseling, the necessity for amniocentesis can be assessed. It is important to recommend counseling in all cases where other signs or defects are present, and also in those cases where a small stomach is the only abnormal finding on repeated ultrasound examinations.
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