TEALE FENNING

Shinelkimo · Joined: 25 Apr 2007 Posts: 55

Q 3 During a routine 20 weeks scan, the fetus is noted to have echogenic bowel. Explain the significance of this and justify your subsequent antenatal management

By definition, EB has a equal echogenicity (or greater echogenicity) to the fetal bone with the same ultrasound machine.

Bowel ischaemia is thought to be the underlying pathology

It is associated with Aneuploidy. However, if no other marker, like suspicious maternal serum markers or advanced maternal age, karyotype is not indicate.

It is associated with Cystic Fibrosis. Maternal blood should be tested for gene mutation. If negative , CF is unlikely

It is associated with IUGR/ uteroplacental insufficiency. Regular fetal growth should be monitored carefully.

It is usually normal unless other fetal pathology abnormaly is found. a repeat ultrasound by a experienced practician 2-4 weeks later is necessary in order to find out fetal anomaly.

It can be confused with calcification. Fetal complication include fetal infection, meconium peritonitis, bowel obstruction or perforation

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973

all very valid points shinelkimo, why not elaborate them and write them as an essay.

Bowel ischaemia is thought to be the underlying pathology --- what else can be the DD?

It is associated with Aneuploidy --- which ones?

Regular fetal growth should be monitored carefully. --- with what? how? how often?

repeat ultrasound ---- mention foetal assesment clinics.

fetal infection --- which? what other investigations will you offer?

it is sbusequent antenatal management -- what about plan for delivery? will you offer termination? if yes - when ? how? why? where?

what about counselling for prognosis?

also look at the CPC essay that has been previously discussed in the forum, might help. remember it is antenatal management = history, investigation, examination and making a plan for management itself.

waiting for your essay. Very Happy

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region