Fetal echogenic bowel: parameters to be considered in differential diagnosis.
OBJECTIVE
To evaluate the extent that associated findings aid in the differential diagnosis and/or prognosis of fetal echogenic bowel.


METHODS
Medical history, obstetric records and outcome details were examined for 131 consecutive pregnancies with fetal hyperechogenic bowel.


RESULTS
In 62 (47%) cases, there were no visible anomalies other than hyperechogenic bowel and no evidence of growth restriction. This group included four (7%) pregnancies with Down syndrome, 15 (24%) with infection or a recent episode of influenza and eight (13%) with blood staining of amniotic fluid. In the remaining 69 (53%) cases, hyperechogenic bowel was accompanied by hydrops or nuchal edema (n = 16, 12.2%), growth restriction (n = 9, 6.9%), other markers for chromosome anomalies (n = 33, 25.2%) or multiple structural anomalies (n = 11, 8.4%). In this group, the prevalence of Down syndrome was 12%, infection or influenza was reported in 14 (20%) cases and there was blood staining of amniotic fluid in seven (10%). Cystic fibrosis screening was performed in 65 (50%) pregnancies; the results were negative in all cases and clinical assessment did not indicate cystic fibrosis in any of the 91 infants who were born alive. Maternal serum screening was performed in 41 (31%) pregnancies. High alpha-fetoprotein levels were associated with multiple abnormalities or severe growth restriction.


CONCLUSIONS
In many pregnancies with fetal hyperechogenic bowel, there are multiple factors that may explain these findings. Thus identification of one potential underlying cause should not preclude further testing. Once chromosome defects, cystic fibrosis, structural abnormalities, infection and growth restriction have been excluded, parents can be counseled that the prognosis is good, irrespective of the presence or absence of blood stained amniotic fluid.
Strocker
A M
AM
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Cedars-Sinai Medical Center Burns & Allen Research Institute, UCLA School of Medicine, Los Angeles, CA, USA.
Snijders
R J
RJ
Carlson
D E
DE
Greene
N
N
Gregory
K D
KD
Walla
C A
CA
Platt
L D
LD
D000293:Adolescent; D000328:Adult; D000653:Amniotic Fluid; D003937:Diagnosis, Differential; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007422:Intestines / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011379:Prognosis; D012307:Risk Factors; D016216:Ultrasonography, Prenatal