Antenatal ultrasound appearance of fetal echogenic bowel What is echogenic bowel? Echogenic bowel is the appearance of a bright area in the baby’s intestine. To understand what echogenic bowel means it is important to know how an ultrasound (or sonogram) machine works. 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. What causes echogenic bowel? There can be many reasons why the baby’s bowel is bright on ultrasound. Mildly echogenic bowel may be a variation of the normal appearance or the baby’s bowel may look bright because the baby has swallowed a little amount of blood. This may be the case if there has been some bleeding earlier in the pregnancy. Swallowing a small amount of blood is not harmful to the fetus. Some babies showing bright bowel, may measure small for the pregnancy dates. Some serious problems that can cause a baby’s bowel to be bright are chromosome abnormalities (such as Down’s syndrome), cystic fibrosis (a genetic disease) and viral infections. Are there different degrees of echogenic bowel? Yes, there are three different degrees 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 bowel that is slightly echogenic and is about as bright as liver. Grade 3 echogenic bowel looks as bright as bone. Will I be offered special testing? Viral infections can be checked for by blood tests. The risk of cystic fibrosis can be predicted by taking blood samples from both parents. Risk of chromosomal abnormality can be assessed by reviewing the results of the screening tests for Down’s syndrome. But the definitive tests for chromosome count are invasive tests (placental biopsy or CVS and amniocentesis) with a 1 in 100 risk of miscarriage. The amniocentesis test is done by removing a small amount of amniotic fluid surrounding the baby. The CVS or placental biopsy involves taking a biopsy from placental tissue. The fluid or placental tissue can then be tested for chromosome abnormalities. 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. What are the chromosome abnormalities? Chromosomes are the packages of genetic information in every cell of the body. Normally, there are 46 chromosomes in every cell. Chromosome abnormalities may involve rearrangements, extra copies of chromosomes or missing chromosomes. Down syndrome is the most common chromosome abnormality. Down syndrome occurs when there is an extra copy of chromosome 21. People with Down syndrome have varying degrees of mental retardation and can have other health problems. Babies can have other chromosome problems, some of them more serious than Down syndrome and some of them less serious. What is cystic fibrosis? Cystic fibrosis is the most common genetic disease among Caucasian people. Children with cystic fibrosis have problems with lung secretions and have recurrent chest infections. They also have problems with enzymes that break down material in the bowel. What are the viral infections that give echogenic bowel? Toxoplasmosis, Rubella, Cytomegalovirus and Herpes are the viral infections that are checked for with echogenic bowel. The implications of a positive test will be discussed by your doctor. What if all the test results are negative (normal)? After all the necessary test results are received, your doctor can discuss what follow-up, if any, is needed. The follow-up will vary depending on the individual situation. Growth problems will be checked by regular antenatal checks and/or scans. In most cases, echogenic bowel goes away over time. Will the baby need any checks after birth? If the echogenic bowel has resolved on scan antenatally and the baby passes meconium and is opening its bowels normally, there is no need for any further checks.
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