This is what I found: it's long.....
Echogenic bowel
what is echogenic bowel?
Echogenic bowel is a bright area, in the
baby’s intestine, shown on the
ultrasound.
What are the chances that my baby will be
healthy?
There is a 53% to 85% chance that
everything is fine. There is such a
variable difference in this percentage
because different sonograms and
sonographers may designate different
degrees of echogenic bowel differenlty.
(see the next question.) thus, if your
baby is diagnosed with a mild echogenic
bowel on one machine, with one
sonographer, it may not be diagnosed at
all in a different situation or it may be
diagnosed as more (or less) severe than
what it really is.
How reliable is an "echogenic bowel"
diagnosis from a sonographer?
An ultrasound machine uses soundwaves (not
radiation) to look at your baby. These
soundwaves bounce back at different speeds
– like an echo in a cave. Soundwaves
that connect with solid tissue (like bone)
bounce back faster and show up brighter
than soundwaves that connect with less
dense structures (like liver). Echogenic
bowel simply means that the baby’s bowel
appears more dense than usual and looks
brighter than normal on the ultrasound.
Now, it's important to note that the
ultrasound machines can be set to
different frequencies and that this can
cause differentiations in the "brightness"
of the results. In one study. Using an 8
mhz frequency, the radiologists
interpreted 31% of cases as having
echogenic bowel, whereas using the 5 mhz
frequency, the radiologists interpreted
only 3% of the cases as having echogenic
bowel. Using the 8 mhz frequency, at
least one of the radiologists interpreted
echogenic bowel in 62% of the cases! (9)
what causes echogenic bowel?
There can be many reasons why the baby’s
bowel is bright on ultrasound:
some non-harmful reasons:
some consider an echogenic bowel "a normal
variant in second-trimester fetuses".
(5)(7)
one common reason that a bowel might
appear bright is immaturity of the
baby’s intestine.
The baby may have swallowed a little
amount of blood. (4) swallowing a small
amount of blood is not harmful to the
fetus. In most cases, echogenic bowel
goes away over time.
Another cause could be an inaccurate
sonogram reading.
Altered meconium composition (3)
some more serious problems:
chromosome abnormalities (including downs
syndrome)
1% chance for cystic fibrosis (a genetic
disease)(6)(7)
15-20% incidence rate for viral infections
(most commonly cmv and torch)(7)
bowel wall ischaemia (fetal disease)(4).
Placental failure (5)
5% risk for cytogenetic problems, such as
trisomy 21(7)
intestinal obstruction
a genetic counselor can discuss more
specific risks for having a baby with one
of these problems depending on the
individual situation.
Are there different degrees of echogenic
bowel?
3 (three) different degree or grades of
echogenic bowel:
grade 1 echogenic bowel is very close to
normal and the bowel is not very bright.
Grade 2 echogenic bowel describes a bowel
that is slightly echogenic and is about as
bright as liver.
Grade 3 echogenic bowel, which is the
highest level, looks as bright as bone.
What sort of tests should be done if an
echogenic bowel was found in our first
sonogram?
Additional sonograms should be ordered to
make sure of the accurateness of the first
sonogram and because the echogenic bowel
may spontaneously resolve itself and cause
no problems for the newborn.(7) "serial
sonograms may help to clarify the findings
with special attention directed to
abdominal ascites and other bowel findings
such as dilatation or development of a
meconium pseudocyst".(7)
will I be offered special testing?
When echogenic bowel is seen, a special
test called an amniocentesis is offered.
The amniocentesis test is done by removing
a small amount of amniotic fluid
surrounding the baby. This fluid can then
be tested for chromosome abnormalities,
infections and cystic fibrosis if
appropriate. Your genetic counselor will
discuss with you more about the benefits
and risks of amniocentesis. Sometimes,
blood tests can be done to check the risk
of infection or cystic fibrosis. The
tests that are offered are different for
each couple. The testing that will be
offered will depend upon family history,
medical history, ethnic background and the
grade or degree of echogenicity seen on
the ultrasound. A genetic counselor can
discuss the specific testing options
available to you in more detail.
What if all the test results are negative
(normal)?
After all the necessary test results are
received, your genetic counselor can
discuss what follow-up, if any, is needed.
The follow-up will vary depending on the
individual situation.
What if I have other positive markers?
In the presence of other risk factors, an
amniocentesis should be discussed with
your doctor.
Echogenic bowel with other signs of
placental failure will require further
growth/liquor/doppler assessment.
Any other markers or risk factors should
prompt discussion of karyotyping.
Blood should be taken for torch screen and
parvovirus serology in some situations.(it
is reasonable to send maternal serum cmv
igg and igm to rule out a primary
infection. Because cmv has other clinical
implications it is important to have this
information prior to delivery.)(7)
if amniocentesis is offered in the
presence of other soft markers,
consideration should be given to dna
analysis for cystic fibrosis.
Alternatively parental carrier status may
be offered on the understanding that any
dna analysis will only detect the known
mutations. Testing after the baby is born
should be considered if prenatal testing
is declined or negative. (these cases are
complex and may require referral to fetal
medicine centres).
Because cf mutation screening is readily
available and reasonably accurate,
clinicians may decide on a case by case
basis whether or not to pursue this
testing. It is best done when both
parents are available and may assist the
pediatricians in caring for the infant at
birth.(7) if this testing comes back
positive, the babies chances for having
cystic fibrosis jumps from 1% to slightly
under 12% following dna analysis.(8)
what complications are associated with
echogenic bowel?
Within one study group, adverse outcomes
occurred in 40 of the 64 fetuses (62%)
with grade 2 or 3 bowel echogenicity,
compared with five of the 31 fetuses (16%)
with grade 1 echogenicity. Echogenic
bowel is associated with an increased risk
of adverse fetal outcome and this risk is
confined primarily to grades 2 and 3
echogenicity.
Some of the complications included (see
above "what causes echogenic bowel?" as
well for more associations):
23% chance for intrauterine growth
retardation (iugr)(5)(8)
low birth weight (5)
16.7% chance for fetal or neonatal
death(8)
other fetal anomalies.
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