Outcomes of Antenatally Diagnosed Isolated or Nonisolated Nonvisualization of the Fetal Gallbladder in a Chinese Population: A Single-Center Cohort Study

Objective: To evaluate the fetal prognosis of prenatally ultrasound-detected nonvisualization of the fetal gallbladder (NVFGB) in Chinese populations for prenatal counseling practice. Methods: This retrospective cohort study examined pregnant women whose fetuses received an antenatal diagnosis of isolated or nonisolated NVFGB at the Fetal Medicine Multi-Disciplinary Consultation Center, Obstetrics and Gynecology Hospital of Fudan University, between January 1, 2010, and February 10, 2023. NVFGB was defined as the inability to identify the fetal gallbladder during two targeted ultrasound examinations conducted within one week. Cases were classified as nonisolated if the ultrasound revealed additional sonographic abnormalities. The primary outcome measure compared the rates of favorable and poor prognoses, where a poor prognosis included biliary atresia, medically indicated termination of pregnancy, or neonatal death. Additionally, the adjunctive clinical utility of prenatal magnetic resonance imaging (MRI) was assessed in specific cases of NVFGB. Results: Fifty-five cases of NVFGB, comprising 27 isolated and 28 nonisolated instances, were included in this study. No marked differences were identified in baseline characteristics, such as maternal age, history of abnormal pregnancy, Down’s screening results, or gestational age at the time of diagnosis. When compared with the nonisolated group, isolated NVFGB was associated with a more favorable prognosis (100.0% vs. 64.3%; P = 0.002; (risk ratio) RR : 1.50, 95% confidence interval ( CI ): 1.149–1.959) and a significantly lower incidence of the composite adverse outcome (biliary atresia, medical indication termination of pregnancy, or neonatal death) (0 vs. 32.1%; P = 0.002; RR : 0, 95% CI : 0–0.837). The incidence of biliary atresia was 0 in the isolated group and 10.7% in the nonisolated group. Among the six cases that underwent MRI screening, the gallbladder was visualized normally in three instances (50%). Conclusion: The results of this retrospective cohort study suggest that isolated NVFGB is associated with a favorable prognosis, whereas nonisolated NVFGB is linked to an elevated risk of poor outcomes, such as biliary atresia or neonatal death. In certain cases where NVFGB is prenatally diagnosed, antepartum MRI may serve as an effective adjunct to detailed structural ultrasound.