Aim Fetal hyperechogenic bowel is an indicator of a number of possible underlying conditions and its identification presents counselling dilemma. Our aim was to identify factors that influence the perinatal outcome when hyperechogenic bowel is diagnosed at midtrimester anomaly scan.

Methods The authors identified a cohort of 44 women with fetal hyperechogenic bowel diagnosed at midtrimester anomaly scan between 2007 and 2009 at University Hospitals Coventry and Warwickshire National Health Service Trust. Criteria for diagnosis included echogenicity of equivalent brightness to the iliac crests, still visible when the ultrasound gain is maximally reduced and confirmed by two independent sonographers.

Results The average gestational age at diagnosis was 20 weeks. Investigations included congenital viral infection screen, cystic fibrosis screen, fetal karyotyping and serial growth scans. The authors noted that hyperechogenic bowel disappeared in 21/44 cases on follow-up scan 4–6 weeks following diagnosis and persisted in 23/44 cases. The authors also observed that fetuses with persistently hyperechogenic bowel had increased incidence of associated anomalies (OR 4.6, 95% CI 1.1 to 20) and undergoing invasive fetal testing (OR 7.3, 95% CI 1.4 to 38) when compared with those with transient hyperechogenic bowel. They also had increased odds of resulting in medical termination of pregnancy (OR 13.5, 95% CI 1.0 to 261) or stillbirth (OR 13.5, 95% CI 1.0 to 261). However, the number of pregnancies affected by intrauterine growth restriction or evidence of intra-amniotic bleed/bleeding in pregnancy did not differ significantly between the two cohorts.

Conclusion Persistently hyperechogenic bowel is more likely to be associated with adverse pregnancy outcome and should be taken into consideration when counselling these women.