Fetal echogenic bowel: parameters to be considered in differential diagnosis

Objectives To evaluate the extent that associated findings aid in the diffe rential diagnosis and/or prognosis of fetal echogenic bowel. Methods Medical history, obstetric records and outcome details were examine d for 131 consecutive pregnancies with fetal hyperechogenic bowel. Results In 62 (47%) cases, there were no visible anomalies other than hyper echogenic bowel and no evidence of growth restriction. This group included four (7%) pregnancies with Down syndrome, 15 (24%) with infection or a rece nt episode of influenza and eight (13%) with blood staining of amniotic flu id. In the remaining 69 (53%) cases, hyperechogenic bowel was accompanied b y 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 structur al 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 w as blood staining of amniotic fluid in seven (10%). Cystic fibrosis screeni ng was performed in 65 (50%) pregnancies; the results were negative in all cases and clinical assessment did not indicate cystic fibrosis in any of th e 91 infants who Mere born alive. Maternal serum screening was performed in 41 (31%) pregnancies. High alpha-fetoprotein levels were associated with m ultiple abnormalities or severe growth restriction. (47%) cases, there than hyperechogenic Conclusions In many pregnancies with fetal hyperechogenic bowel, there are multiple factors that may explain these findings. Thus identification of on e potential underlying cause should not preclude further testing. Once chro mosome defects, cystic fibrosis, structural abnormalities, infection and gr owth restriction have been excluded, parents can be counseled that the prog nosis is good, irrespective of the presence or absence of blood stained amn iotic fluid.