Purpose Intestinal abnormalities are sometimes seen during antenatal testing, however the postnatal importance of these findings has not been well established. We evaluated whether abnormal intestinal appearance on fetal ultrasound (US) was ultimately related to neonatal outcome. Methods Fetal US exams from 2003–2006 were evaluated. Hyperechogenic bowel was defined as having the echogenicity comparable to bone, and dilated bowel was identified based on the sonographer’s assessment. Persistence or resolution of US findings on subsequent US exams and eventual outcomes were assessed. Cases were categorized as hyperechogenic or dilated, and then sub-grouped based on whether or not the US finding resolved. Results Sixty-eight fetuses had either hyperechogenic (n=48) or dilated bowel (n=20) on antenatal US. In 56 cases, complete data were available for analysis. Of 44 liveborn infants, 11 (25.0%) had an abdominal abnormality and 33 (75.0%) were normal at birth. Compared to those with dilated bowel, fetuses with hyperechogenic bowel had a higher rate of prenatal demise (20.8% vs 10%) but a lower rate of abnormality at birth (10.3% vs 53.3%). Hyperechogenic bowel resolved on subsequent US more frequently than dilated bowel (65.5% vs 20.0%). In both groups, all fetuses with sonographic resolution were normal at birth. Three of 9 fetuses (33.3%) that had persistently hyperechogenic bowel were born with an abnormality and all were found to have meconium peritonitis or meconium ileus. In the 12 cases where dilated bowel did not resolve, 8 (66.7%) were eventually born with an abnormality, most commonly intestinal atresia. Conclusions Hyperechogenic and dilated bowel are associated with a significant rate of fetal demise. Hyperechogenicity is more common than dilation and is more likely to be transient. Dilated bowel is more often associated with neonatal abnormality than hyperechogenic bowel. Persistence of fetal ultrasound findings predicts a higher likelihood of abnormality in the neonate.

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