Clinical significance of prenatal double bubble sign on perinatal outcome and literature review

J Matern Fetal Neonatal Med. 2022 May;35(10):1841-1847. doi: 10.1080/14767058.2021.1874338. Epub 2021 Jan 17.


Objective: To determine the diagnostic accuracy of the double bubble sign in predicting duedonal obstruction, the prevalence of anomalies associated with congenital duedonal obstruction, and to evaluate the outcome of these pregnancies and review the literature.

Methods: We analyzed that the cases with double bubble sign were detected in prenatal ultrasonography between January 2014 and December 2019. Ultrasound reports, karyotyping results, surgical confirmed diagnoses and long-term results were extracted from the hospital database.

Results: Duodenal obstruction was detected in all operated cases with double bubble sign detected in prenatal ultrasonography. Karyotype anomaly was found in 63.9% and additional congenital anomaly was found in 69.4%. Adverse perinatal outcome was seen in 51.1% of cases. Adverse perinatal outcome was found significantly higher in abnormal karyotype and congenital anomaly groups than isolated group. 81.8% of the isolated cases lived after the operation. Only two isolated cases died.

Conclusion: The prenatal double bubble sign is a highly reliable predictor for duodenal obstruction and structural anomalies and/or genetic abnormalities are present in the majority of cases. Duodenal obstruction is isolated, the outcomes appear favorable.

Keywords: Double bubble sign; congenital anomaly; karyotype; perinatal outcome; prenatal diagnosis.

Publication types

  • Review

MeSH terms

  • Abnormal Karyotype
  • Duodenal Obstruction* / congenital
  • Duodenal Obstruction* / diagnostic imaging
  • Female
  • Humans
  • Pregnancy
  • Prenatal Diagnosis
  • Ultrasonography, Prenatal