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Fetal intra‐abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery
Author(s) -
Zangheri Giulia,
Andreani Marianna,
Ciriello Elena,
Urban Gabriele,
Incerti Maddalena,
Vergani Patrizia
Publication year - 2007
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.1812
Subject(s) - meconium peritonitis , medicine , polyhydramnios , obstetrics , exact test , meconium , fetus , prenatal diagnosis , pregnancy , gynecology , surgery , genetics , biology
Objective To study the relationship between prenatal ultrasound features and postnatal course of meconium peritonitis. Study Design We reviewed our cohort of cases of meconium peritonitis (MP) ( n = 13/37, 225 pregnancies or 0.3/1000) as well as those published in the English literature with prenatal ultrasonographic findings and postnatal follow‐up ( n = 56). The total number of cases ( n = 69) was divided into 4 grades of progressive severity based on the number of pertinent sonographic findings: grade 0, isolated intra‐abdominal calcifications ( n = 18); grade 1, intra‐abdominal calcifications and ascites ( n = 17) or pseudocyst ( n = 2) or bowel dilatation ( n = 6); grade 2, two associated findings ( n = 20); and grade 3, all sonographic features ( n = 6). Presence of polyhydramnios was also recorded. Prenatal predictors of need for neonatal surgery and risk of neonatal death were identified using Chi‐square and Fisher exact test, with P < 0.05 considered significant. Results Neonatal surgical intervention was required in 0% (0/18) of newborns with grade 0 MP; in 52% (13/25) of those with grade 1; in 80% (16/20) with grade 2; and in 100% (6/6) with grade 3 MP ( P < 0.001, Chi‐square for trend). Moreover, neonatal surgery was more frequent in the presence than absence of polyhydramnios [69% (18/26) vs 37% (16/43); P = 0.007]. Neonatal mortality was 6% (4/69; 3 after surgery and 1 for premature delivery) and it was confined to the subgroup with polyhydramnios (4/26, 15%). Conclusions Prenatal sonographic features are related to postnatal outcome. Persistently isolated intra‐abdominal calcifications have an excellent outcome. Delivery in a tertiary care center is recommended when calcifications are associated with other sonographic findings. Copyright © 2007 John Wiley & Sons, Ltd.