Fetal echogenic bowel in the second trimester-prognostic implication

OBJECTIVE: Several etiologies for fetal echogenic bowel have been reported in the second trimester including chromosomal abnormalities, cystic fibrosis, cytomegalovirus (CMY) infection, and intra-arnniotic bleeding. The purpose of ihis study was to evaluate our experience in the diagnosis and management o!' fetal echogenic bowel. METHODS: 79 patients diagnosed with echogenic bowel in the second trimester were included. Patients were offered genetic counseling, chromosomal analysis bv amniocentesis, serological evaluation for infectious agents including toxoplamosis, rubella. CMV and herpes (TORCH), and DNA analysis for cystic fibrosis. RESULTS: Thirteen cases uere associated with maternal bleeding episodes, ot these 7 patients underwent amniocentesis, and (i had evidence of old blood in the amniolic fluid. Seven cases had associated severe malformation, 7 cases were noted in multifetal pregnancies, and .1 others had evidence of bowel obstruction or perforation not associated with (.¥. Five cases of chromosomal aberration included 3 cases of trisomv 21. one of trisomy 13 and one of 46,X.im (X) (q!3q26). In 5 cases an intrauterine infection has been implicated including '2 cases of CMY infection and one case each of varicella /oster virus, human herpes virus, and pancnirus B-19. Three cases were associated utili stillbirth. Two fetuses were found to have cystic fibrosis ( 1:40). Finally, in 32 cases. (40.5% ) no obvions reason foi the echogenic bowel was found. bleeding- malfor-mation- obstnn- pour bleeding watiwi !win\ DI jet-lion \ome\ lion oitffowc ('.}' 13 7 7 5 5 3 2 16.4% H.9% 8.9% 6.3% f>.3 3.3.8% 2.5% CONCLUSION: We conclude 1) Thai a (borough search foi a the cause of echogenic bowel should include targeted ultrasound to rule out associated malformations. 2) TORC.II IgM studies that may be extended to include other pathogens such as varicella /osier virus and parvovirm: 3) DNA studies loi cvstic fibrosis. amniocentesis for chromosomal analvsis and evaluation of the amniotic fluid for degraded blood products; 4) F.ven when no apparent reason is found, pregnancies should be consideied at high risk for poor c ntcorne.