Prenatal diagnosis and fetal outcomes of meconium peritonitis

Abstract

Objective To discuss prenatal ultrasound features and fetal outcomes of meconium peritonitis. Methods This is a retrospective study of all cases of fetal meconium peritonitis (n=26) registered in the Department of Obstetrics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 1, 2004 to December 31, 2014. Prenatal ultrasound features, surgical findings and fetal outcomes were discussed. Variance analysis, Chi-square test or Fisher's exact test were applied for statistics. Results Among the 26 cases, 25(96.2%) were diagnosed prenatally, 24 (92.3%) underwent neonatal surgery, and 24 (92.3%) survived. Prenatal ultrasound findings included bowel dilatation (88.5%,23/26), intra-abdominal calcification (42.3%,11/26), fetal ascites (30.8%, 8/26), intra-abdominal pseudocysts (15.4%, 4/26) and polyhydramnios(50.0%,13/26). Surgical findings confirmed the diagnosis of meconium peritonitis was due to jejunal atresia[16.7%(4/24)], ileal atresia[75%(18/24)], and atresia of jejunal and ileal junction [8.3%(2/24)], respectively. However, no statistical significance was shown in the incidence of bowel dilatation, intra-abdominal calcification, fetal ascites, pseudocysts and polyhydramnios among the three groups of different etiology (all P>0.05). Conclusions The prenatal ultrasound features of meconium peritonitis may vary a lot. But bowel dilatation combined with intra-abdominal calcification, fetal ascites or pseudocysts prompts the diagnosis of meconium peritonitis. Early surgical intervention in neonatal period could reduce the neonatal mortality remarkably, thus comprehensive and standardized perinatal management are necessary to improve fetal outcomes. Key words: Peritonitis; Meconium aspiration syndrome; Ultrasonography, prenatal; Treatment outcome