title: Accuracy of prenatal detection of tracheoesophageal fistula and oesophageal atresia.
abstract: OBJECTIVE
  This study aims to determine the rate of prenatal detection of tracheoesophageal fistula and oesophageal atresia (TOF/OA), by identifying a small or absent stomach bubble with or without polyhydramnios, on the prenatal ultrasound scans (USS).
  
  
  METHODS
  A retrospective study of prenatal ultrasound findings of babies with a prenatal and postnatal diagnosis of TOF/OA born between 1st January 2004 and 31st December 2013 was undertaken.
  
  
  RESULTS
  A total of 58 babies were born with TOF/OA. 40% of mothers had their prenatal investigations performed within our tertiary centre, and the remaining 60% had their antenatal care at their local district general hospital (DGH). The overall sensitivity for prenatal USS was 26%, with a specificity of 99% and a positive predictive value (PPV) of 35%. However, the sensitivity of the prenatal USS within the tertiary centre was significantly higher at 57%, while only 2 cases were detected prenatally in the DGHs. Polyhydramnios was seen in 67% of mothers that had a prenatal diagnosis of TOF/OA and its presence did significantly increase the positive predictive value of prenatal USS (from 35% to 63%). Of those that were postnatally diagnosed, 21% had prenatal polyhydramnios. There was no significant difference in postnatal outcomes between those that were prenatally diagnosed and those that were postnatally diagnosed.
  
  
  CONCLUSIONS
  Prenatal diagnosis of TOF/OA remains challenging. However within a specialist centre the accuracy of successful prenatal detection can be significantly improved. This is beneficial both for prenatal counselling of families and for planning appropriate perinatal and postnatal care for the baby.
authors.affiliation: Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK. Electronic address: catherinebradshaw@doctors.net.uk.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Bradshaw
authors.affiliation: Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
authors.forename: Hemanshoo
authors.initials: H
authors.lastname: Thakkar
authors.affiliation: Department of Fetal Medicine, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
authors.forename: Liz
authors.initials: L
authors.lastname: Knutzen
authors.affiliation: Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Marsh
authors.affiliation: Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pacilli
authors.affiliation: Department of Fetal Medicine, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
authors.forename: Laurence
authors.initials: L
authors.lastname: Impey
authors.affiliation: Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
authors.forename: Kokila
authors.initials: K
authors.lastname: Lakhoo
mesh_terms: D004933:Esophageal Atresia / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006831:Polyhydramnios / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011295:Prenatal Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013270:Stomach / Q000000981:diagnostic imaging / Q000196:embryology; D014138:Tracheoesophageal Fistula / Q000000981:diagnostic imaging*; D016216:Ultrasonography, Prenatal
keywords: Fetal anomaly scan; Oesophageal atresia; Prenatal detection; Prenatal ultrasound; Tracheoesophageal fistula