Roentgen amniography: a valuable and safe aid to obstetrical diagnosis.

Abstract

Essentially, amniography consists of opacifying the amniotic fluid in the pregnant uterus with a suitable contrast medium in order to delineate the uterine cavity and to study certain aspects of maternal and fetal physiology. The method has undergone many vicissitudes. Menees and Holly and their collaborators (1, 2), who originated the procedure in 1930, used it near term with the chief purpose of determining the location of the placenta. They accomplished the opacification by puncturing the abdomen and uterus with a long needle through which sodium or strontium iodide was injected. The reproductions in their early reports show clearly the opacified amniotic fluid and reveal the floating fetus with its soft tissues as a “negative shadow.” The amniotic sac was seen to conform to the pyriform configuration of the gravid uterus except in one area, where the symmetry was interrupted by a filling defect identified as the placenta. Menees and his associates were able to locate the placental site correctly each time they used the method. They also noted that the fetus swallowed the opaque medium, which could be seen in the fetal bowel. While the originators stated that the method was safe in their hands, several other workers, notably Kerr and Mackay (3) and Cornell and Case (4), felt that it was dangerous and of rather limited use, suggesting that it should be abandoned. Sodium and strontium iodide were considered too irritating as contrast media, resulting in several fetal deaths and too frequently in undesirable induction of labor. Cornell and Case also warned against the danger of puncturing vital fetal structures with the needle or entering the large vessels of the placenta or the umbilical cord, producing a lethal hemorrhage. These authors abandoned the inorganic iodides as contrast media, using Neoskiodan or Uroselectan B instead. The latter was found to induce labor so regularly that Burke (7) began to use the medium for that special purpose. He found amniotic puncture in itself to be without harmful effects to the mother or fetus in 75 consecutive cases. Cetroni and Azzariti (5), as well as Albano and Gallina (6), stated that the method was safe with either the organic or inorganic iodides available in 1934. Amniography in advanced pregnancies was apparently abandoned following these controversies, since it received no further mention in the literature until 1948, when numerous articles appeared in French publications, chiefly under the authorship of Granjon and numerous collaborators (10–14). Ginglinger (9) and Reid (15) also used the method. These authors recommend the media ordinarily employed in intravenous pyelography. Granjon (11) tried several products and found the American and Swedish preparations to be the most satisfactory. He insists that the method is free of any danger to the maternal or fetal organism.