OBJECTIVE: To review pregnancy outcome data after ultrasound exams persistently fail to visualize the fetal stomach. STUDY DESIGN: A computerized ultrasound database was used to identify all fetuses in whom two or more serial ultrasound exams failed to visualize the fetal stomach. Sonographic images were retrospectively reviewed, with the reviewer blinded to outcome data, to confirm persistent nonvisualization. Pregnancy outcome data was obtained from hospital charts and physician office records. Fetal karyotypes, when performed, were obtained from amniotic fluid culture. The ultrasound findings were then compared to fetal karyotype results and pregnancy outcome data. RESULTS: From 1991-1996, 27 fetuses with persistently nonvisualized stomachs were identified. Fetal structural defects were detected in 17 fetuses (63%), most often involving either the genitourinary (N = 5), cardiothoracic (N = 4), central nervous (N = 3), or gastrointestinal systems (N -2). Fifteen fetal karyotypes were obtained and 4 (27%) of these were abnormal. Fetal growth restriction was detected in 5 fetuses (19%) and abnormal amniotic fluid volumes were found with 19 fetuses (70%) (Poly = 13, Oligo = 6). There were 11 deliveries <37 weeks (41%), 7 fetal deaths ( 26% ), 3 induced abortions (11%), 5 neonatal deaths ( 19% ), and 2 infant deaths (7%). Ten infants survived (37%) and only 6 survivors (22%) did not have a birth defect. CONCLUSIONS: Fetuses with a persistently nonvisualized stomach have an increased incidence of serious structural defects and chromosomal abnormalities and thus are more likely to have a poor pregnancy outcome. A detailed ultrasound examination and fetal karyotype analysis should be performed to evaluate fetuses with persistently nonvisualizeri stomachs.