Meconium peritonitis in utero---the value of prenatal diagnosis in determining neonatal outcome.
OBJECTIVE
Meconium peritonitis (MP) is a chemical peritonitis caused by fetal intestinal perforation in utero. Its incidence is rare, but serious neonatal morbidity or even mortality can occur if the diagnosis is not made until after birth. Prenatal diagnosis is important in prompting early postnatal surgical intervention, and so improving neonatal outcome.


METHODS
Fourteen cases diagnosed in utero with MP from January 1996 to December 2005 were enrolled in this study. The final diagnoses were established by surgical findings or postnatal radiography. The prenatal ultrasound features, neonatal birth characteristics, surgical findings, postnatal management and neonatal outcomes were reviewed.


RESULTS
All infants received follow-up care at our hospital. Prenatal ultrasound findings included fetal ascites (100%), intra-abdominal calcification (93%), dilated bowel loops (57%), pseudocysts (29%), and polyhydramnios (50%). Four infants (4/14; 28.5%) did not undergo postnatal surgery, but survived well. The mean gestational age at detection was significantly earlier in the non-surgery group (23+/-3.6 weeks) than in the surgery group (31.7+/-2.5 weeks). One infant (7.1%) died because of sepsis after two neonatal operations. The overall survival rate was 92.9%.


CONCLUSIONS
MP can be diagnosed by prenatal ultrasound, and the neonatal outcome is favorable. Early detection is not associated with poor neonatal outcome, and selective termination is unnecessary. Resolution of dilated bowel loops and polyhydramnios predict a low rate of postnatal surgical intervention.
Wang
Chao-Nin
CN
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang
Shuenn-Dyh
SD
Chao
An-Shine
AS
Wang
Tzu-Hao
TH
Tseng
Ling-Hong
LH
Chang
Yao-Lung
YL
D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000150:complications / Q000196:embryology; D008297:Male; D008470:Meconium; D010538:Peritonitis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D011247:Pregnancy; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal