Presented at the Neonatal Society 2015 Autumn Meeting.
Qureshi Q1, Exley K, Lal MK
1 Neonatal Unit, The James Cook University Hospital, Middlesbrough TS4 3BW
2 Department of Fetal Medicine, The James Cook University Hospital, Middlesbrough TS4 3BW
Background: Fetal echogenic bowel (FEB) is a non-specific soft marker detected on antenatal second trimester ultrasound scans. It may be transient and of little clinical significance, however, it could also be a sign of underlying pathology such as congenital infections, cystic fibrosis and aneuploidy. Aim: To determine the outcome of all cases of fetal echogenic bowel (FEB) identified on second trimester antenatal ultrasound scan.
Methods: All cases of FEB between July 2006 and June 2014 from all antenatal bookings at The James Cook University Hospital, South Tees NHS Trust, as recorded prospectively in the maternity ultrasound and fetal medicine database, were included. Medical records of each case were reviewed and information concerning additional investigations and perinatal outcomes were recorded. There was no external funding for this project and ethical approval was not required as only anonymised patient records were reviewed. All identified cases were divided into 3 groups. Group 1 consisted of cases of isolated FEB. Group 2 consisted of cases of FEB with intrauterine growth restriction (IUGR). Group 3 included FEB associated with major congenital abnormalities or 1 or more additional sonographic abnormalities.
Results: There were a total of 36,171 booked pregnancies over the 8 year period, with a total of 36 cases of FEB with an incidence of 0.1%. Twenty seven pregnancies (75%) resulted in a live birth. In 5 cases (14%), there was termination of pregnancy and 4 cases (11%) were complicated by intra-uterine death. Out of 27 babies born alive, 2 babies died in neonatal period (one was a preterm 26 weeks gestation baby who died on day 28 of life with enterococcus sepsis and other was a baby with Beckwith-Wiedemann syndrome who died on day 4 of life.
Outcome of Group 1: Of 18/36 cases (50%) in this group, 16 had normal outcome. One baby had congenital cytomegalovirus (CMV) infection and the other had spontaneous miscarriage.
Outcome of Group 2: Of 8/36 (22%) babies in this group, 5 had normal outcome. Two babies had intra-uterine death (IUD) and 1 preterm baby died on day 28 after birth with enterococcus sepsis.
Outcome of Group 3: Of 10/36 cases (28%), 2 babies had normal outcome, 1 baby had jejunal atresia. There were 5 terminations of pregnancy (CMV, Trisomy 21, Trisomy 18, 2 cases of multiple fetal abnormalities), 1 stillbirth (Trisomy 21) and 1 neonatal death on day 4 with Beckwith-Wiedemann syndrome.
Conclusion: There is good prognosis and mostly normal outcome in cases of isolated FEB. Prognosis is less favourable if FEB is present along with IUGR or additional ultrasound abnormalities or major congenital abnormalities. The findings of this study will help during antenatal counselling of parents.
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