Background: Esophageal atresia (EA), with or without tracheoesophageal fistula (TOF) is one of themost correctable fetal anomalies if diagnosed antenatally by serial ultrasound. We retrospectivelyevaluated antenatal diagnoses by ultrasound of EA with or without TOF at our institution in SaudiArabia. Patients and Methods:We examined the records of mothers and infants with EA with or without TOFwho were booked early and delivered at our institution during 1994 to 1998. Fetal diagnosis wasbased on level II serial ultrasound using a high-resolution ultrasound machine (n=78). Results: In the 5-year period, there were 58 491 live births, with 1345 congenital abnormalities (2.3%)and 78 cases of EA with or without TOF (0.13%) diagnosed antenatally. The survival rate was 68% forwomen with vaginal deliveries and 60% for women with caesarean deliveries, so caesarean deliverydid not improve outcome. The Apgar score was 7 or greater at 5 minutes in 65 cases (83.5%), whichemphasizes the problems such patients develop after delivery. Death was caused by anomalies otherthan EA that were incompatible with life, or in the post-operative period, by septicemia, renal failure orcot death. Conclusions: Our study suggests that early antenatal booking, serial ultrasound and early antenataldiagnosis improves outcome in EA with or without TOF.