Factors associated with fetal demise in fetal echogenic bowel

OBJECTIVE: The purpose of this study was to determine risk factors associat ed with intrauterine fetal demise in fetuses with unexplained echogenic bow el that is diagnosed in the second trimester. STUDY DESIGN: A retrospective case-control study compared fetuses with echo genic bowel and fetal demise with fetuses with echogenic bowel who were liv e born. Fetuses affected with cystic fibrosis, aneuploidy, or congenital in fection and fetuses diagnosed with major anomalies were excluded. Variables examined in the determination of risk factors for intrauterine fetal demis e included intrauterine growth restriction, oligohydramnios, elevated mater nal serum alpha-fetoprotein levels, and elevated maternal serum beta -hCG l evels. Statistical analysis was performed with the Fisher exact test, Stude nt t test, and logistic regression analysis. RESULTS: One hundred fifty-six fetuses met the inclusion criteria. There we re 9 cases of intrauterine fetal demise and 147 live born control fetuses. The median gestational age of intrauterine fetal demise was 22.0 weeks (ran ge, 17-39 weeks). Intrauterine growth restriction occurred more frequently in cases of intrauterine fetal demise than in live born infants (22.2% vs 0 .7%; P = .009), as did oligohydramnios (44.4% vs 2.0%; P < .001) and elevat ed maternal serum alpha-fetoprotein levels (80.0% vs 7.7%; P = .001). With the use of logistic regression analysis, elevated maternal serum alpha-feto protein was the strongest independent risk factor that was associated with intrauterine fetal demise (odds ratio, 39.48; 95% Cl, 11.04%-141.25%). CONCLUSION: In our series, there was a 5.8% incidence of intrauterine fetal demise in fetuses with unexplained echogenic bowel. Elevated maternal seru m alpha-fetoprotein is the strongest predictor of fetal demise in fetal ech ogenic bowel.