Fetal intra-abdominal calcifications from meconium peritonitis: Sonographic predictors of postnatal surgery

San Gerardo Hospital, Italy.
Prenatal Diagnosis (Impact Factor: 3.27). 10/2007; 27(10):960-3. DOI: 10.1002/pd.1812
Source: PubMed


To study the relationship between prenatal ultrasound features and postnatal course of meconium peritonitis.
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.
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%).
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.

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    • "Grade 0, isolated intra-abdominal calcifications; grade 1, intra-abdominal calcifications and ascites or pseudocyst or bowel dilatation; grade 2, two associated findings; grade 3, all sonographic features. The authors found an increasing need for neonatal surgery with higher grades of the sonographic classification [7]. Another study also found a correlation between ultrasound features and clinical implications [8]. "
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