OBJECTIVE To determine which sonographic findings predict intestinal damage in fetuses with gastroschisis, and to develop objective criteria that may be useful in selecting candidates for preterm delivery. METHODS Twenty-four consecutive fetuses at two perinatal centers were assessed retrospectively or prospectively. Maternal, perinatal, and sonographic data were recorded and correlated with postnatal outcome. RESULTS Bowel diameter of at least 18 mm was associated with a significantly longer time to oral feeding and with significantly greater need for bowel resection. When gestational age was plotted against bowel diameter, a threshold curve was generated, above which all patients had prolonged hypoperistalsis and below which only 30% had prolonged hypoperistalsis. Two infants were delivered at 33 weeks' gestation, both of whom had complications potentially related to prematurity. Only one of 22 patients who delivered later than 33 weeks had similar complications. CONCLUSIONS Bowel dilatation may be a marker of prenatal bowel damage in fetuses with gastroschisis, especially when it presents late in gestation. Prenatal sonography may be useful in selecting appropriate fetuses for preterm delivery.