Prognostic implications of fetal echogenic bowel

Slotnick, Robert Nathan
Abuhamad, Alfred Z.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23507, USA (R N Slotnick MD, A Z Abuhamad MD).
Correspondence to: Dr Robert N Slotnick

The Lancet 347(8994):p 85-87, January 13, 1996.

Summary

Background An increased frequency of hyperechogenic bowel on ultrasound has been reported in fetuses with cystic fibrosis (CF) and trisomy-21. However, the diagnostic application of this observation has been hampered by the absence of a means of measuring echogenicity.

Methods We devised an ultrasonic grading system in which echogenicity was quantified by linear gain reduction and comparison with fetal iliac crest.From 7400 second-trimester ultrasound referrals, 145 patients were identified as having a fetus with abnormally echogenic bowel. They were offered genetic counselling, parental and (if appropriate) CF carrier testing, and amniocentesis for karyotype and CF status if parents were informative. Follow-up was to 4 months of age.

Findings Of 40 fetuses with mild increase in bowel sonodensity (grade 1), none had CF or aneuploidy.Of 81 patients identified with a moderate increase (grade 2), 2 had trisomy 21 and 2 had CF. And of 24 pregnancies with a pronounced increase (grade 3), 5 had CF and 6 had trisomy-21.

Interpretation Parental CF carrier testing and amniocentesis to identify aneuploidy or fetal CF status has a high positive ascertainment rate in fetuses with echogenic bowel grades 2 and 3.

Lancet 1996; 347

85-87