title: Fetal intra-abdominal calcifications from meconium peritonitis: sonographic predictors of postnatal surgery.
abstract: OBJECTIVE
  To study the relationship between prenatal ultrasound features and postnatal course of meconium peritonitis.
  
  
  METHODS
  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.
authors.affiliation: San Gerardo Hospital, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Zangheri
authors.forename: Marianna
authors.initials: M
authors.lastname: Andreani
authors.forename: Elena
authors.initials: E
authors.lastname: Ciriello
authors.forename: Gabriele
authors.initials: G
authors.lastname: Urban
authors.forename: Maddalena
authors.initials: M
authors.lastname: Incerti
authors.forename: Patrizia
authors.initials: P
authors.lastname: Vergani
mesh_terms: D002114:Calcinosis / Q000151:congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008470:Meconium; D010538:Peritonitis / Q000151:congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012720:Severity of Illness Index; D016216:Ultrasonography, Prenatal