Outcomes for fetal echogenic bowel during the second trimester ultrasound

Iruretagoyena, J. Igor; Bankowsky, Heather; Heiser, Timothy; Birkeland, Laura E.; Grady, Margo; Shah, Dinesh

doi:10.3109/14767050903551442

Cited by 16 publications

(20 citation statements)

References 6 publications

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“…Although there have been reported associations with toxoplasmosis, parvovirus, varicella and herpes, our findings correlate with studies that have found CMV as the most likely infective agent [6,7]. These results support the suggestion that CMV may be the only virus needing further testing in cases of ultrasound-diagnosed FEB [6,7,8] in the Australian population.…”

Section: Discussionsupporting

confidence: 81%

Perinatal Outcomes following the Ultrasound Diagnosis of Echogenic Bowel: An Australian Perspective

Ameratunga¹,

Said²,

Reidy³

et al. 2012

Fetal Diagn Ther

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Introduction: The aim of this study was to describe the association between fetal echogenic bowel (FEB) diagnosed during the second trimester and adverse perinatal outcomes in an Australian antenatal population. Methods: A retrospective analysis of ultrasound scans was performed between March 1, 2004 and March 1, 2009 at The Royal Women’s Hospital, Melbourne, Vic., Australia. Cases reported as having FEB on second trimester ultrasound were included. Medical records of each case were reviewed and information concerning additional investigations and perinatal outcomes were extracted. Results: A total of 66 cases were identified in our database. Three patients (5%) were excluded from further analysis as they were lost to follow-up, leaving 63 (95%) cases in this series. Thirty-two fetuses (52%) underwent karyotyping via amniocentesis, 5 (16%) of which were found to have chromosomal defects. Maternal serology for cytomegalovirus (CMV) was performed in 49 (78%) cases. Investigations indicated a total of 5 women who had CMV infection during their pregnancy. Thirty-three pregnancies (53%) were tested for cystic fibrosis (CF) and 1 baby was confirmed to have CF postnatally. Among the 50 liveborn infants, 3 cases of fetal growth restriction were apparent. Overall, 42 of the 50 liveborn infants (84%) and 67% of the entire cohort of 63 patients with a midtrimester diagnosis of FEB had a normal short-term neonatal outcome. Conclusion: This study reiterates the increased prevalence of aneuploidy, CMV, CF and fetal growth restriction in pregnancies complicated by the midtrimester sonographic finding of FEB. However, reassuringly, 67% of cases with ultrasound-detected echogenic bowel in the second trimester had a normal short-term neonatal outcome in this multiethnic Australian population.

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Section: Discussionsupporting

confidence: 81%

Perinatal Outcomes following the Ultrasound Diagnosis of Echogenic Bowel: An Australian Perspective

Ameratunga¹,

Said²,

Reidy³

et al. 2012

Fetal Diagn Ther

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“…Nine fetuses showed hyperechogenic bowel, which was associated with ultrasound brain abnormalities in six cases, hepatomegaly in one case, and isolated findings in two cases. The significance of hyperechogenic bowel in pregnancy remains unsettled [26–28]. However, our three fetuses with hyperechogenic bowel without ultrasound brain abnormalities at 21 weeks of gestation but with moderate and severe histological brain damage presented a high CMV load in the amniotic fluid.…”

Section: Discussionmentioning

confidence: 89%

“…Group A: seven fetuses with severe cerebral damage (score [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Histological findings. Brain: CMV-positive cells were found in the cortex, white matter, germinal matrix, grey matter, ependyma, and leptomeninges.…”

Section: Resultsmentioning

confidence: 99%

Congenital cytomegalovirus infection: patterns of fetal brain damage

Gabrielli

Bonasoni

Santini

et al. 2012

Clinical Microbiology and Infection

104

101

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Cytomegalovirus (CMV) is the most prevalent infectious agent causing neurological dysfunction in the developing brain. This study analysed the different patterns of tissue damage, particularly in the brain, of fetuses with documented CMV infection. We studied 45 fetuses at 20-21 weeks of gestation with congenital CMV infection documented by invasive positive prenatal diagnosis. At the time of amniocentesis, abnormal ultrasound findings had been recorded for 13 of the 45 fetuses (29%). Histological and immunohistochemical characterization was performed on the placenta, brain, heart, lung, liver, kidney, and pancreas. The different degrees of brain damage were correlated with tissue viral load, inflammatory response, placental functionality, and extramedullary haematopoiesis. Even though a high CMV load was detected in all amniotic fluids, brain infection occurred in only 62% of the fetuses and with different degrees of severity. Tissues with a low viral load showed a globally weak inflammatory response, and fetuses had only mild brain damage, whereas tissues with a high CMV load showed prominent infiltration of the activated cytotoxic CD8(+) T-lymphocytes responsible for immune-mediated damage. Furthermore, severe placental infection was associated with diffuse villitis and necrosis, consistent with functional impairment and possible consequent hypoxic cerebral damage. Brain injury induced by CMV congenital infection may be the result of uncontrolled viral replication, immune-mediated damage by cytotoxic CD8(+) T-lymphocytes, and, in the presence of placental insufficiency, fetal hypoxia.

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“…We had no cases of toxoplasma or parvovirus infection. Other studies report a similarly low prevalence for congenital toxoplasma and CMV ranging from 0.01–1.7% . However, the studies that include screening for a wider variety of infections, such as herpes simplex virus, varicella zoster virus, parvovirus and influenza, not surprisingly, report much higher incidences of up to 20% .…”

Section: Commentmentioning

confidence: 96%