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Small stomach at 20 and 22 week U/S--possible tracheoesophageal fistula

On my 20 week ultrasound 2 observations stood out. First a variation in the heart that could be normal, but is sometimes associated with Downs Syndrome (I'm forgetting the name) and a small stomach.  I am 42 years old and this is a natural conception with progesterone support for the first 3-and-a-half months. The baby's growth has been on target and my risks for Downs came out less than 1 in 4,000 from the combined sequential genetic blood tests and ultrasound. I did have a subchorionic hematoma in my first trimester, which is now completely resolved. I have had no invasive tests as I do not want even the slightest increase of miscarriage risk.

On the follow up ultrasound at 22 weeks the stomach was still small. I am now scheduled for an ultrasound at 28 wks.  I was told that if there is a tracheoespophageal fistula it would likely be viewable at that time. I have not been given any percentages or normal ranges for stomach size. The fact that the small size was observed twice now concerns me. How often is a small stomach connected to such a problem?  The fistula sounds serious and would require surgery.  How often are small stomachs seen that turn out to be normal?  Is there a time of day that's more likely to be after the fetus has swallowed? At what gestation can normality or defect be confirmed? I still have 5 weeks to wait for the next ultrasound. The perioneonatologist seemed reassured that there was a stomach. I know it is not standard to be observed this closely, so I know my baby is at increased risk.  What are other possible associations with a small stomach? What are possible causes for a small stomach and for a tracheoesophogeal fistula? Could formaldehyde exposure contribute to a possible defect such as this fistula? I was exposed at the end of my first trimester--sleeping on unwashed new sheets 2 nights in a row.

I am hoping that more information and context will help me better deal with the unknown. Thank you.
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Congratulations!  I feel fairly certain that your baby is healthy and normal.  I suspect that what they saw in the heart was an EIF(echogenic intracardiac focus). I absolutely hate those things, because we have to report them and what they could mean, but I have never yet seen it associated with Downs, and I have seen it many times.

As for the small stomach--usually if there is a TE fistula, the stomach is never visualized at all, so I suspect this is yet another non-issue.  We can see so much on ultrasound now, that we can't handle all of the information, and we end up scaring the parents to death.

If you were my patient, I would definitely reccomend the 28 week scan (can they do 4D for you?) and I'll bet that you'll see a healthy kid!  In the meantime, buy some cute baby clothes and get a pedicure.  Take a nap too--at 42 its going to be hard to keep up with a baby--believe me--I KNOW!

Good luck!
Dr B
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