Oral or Poster Presentation
Concurrent Session 4D - Maternal Fetal Medicine
Introduction: Previous studies have attempted to elucidate fetal sonographic findings associated with a need for postnatal surgery. These studies mostly originated from single centers, involved a relatively small cohort and results were largely based on descriptive statistics. Our aim was to describe the postnatal outcome of fetal meconium peritonitis and identify prenatal predictors of neonatal surgery.
Methods: We retrospectively reviewed all fetuses with fetal ultrasound findings suspicious of meconium peritonitis (ascites, abdominal calcifications and meconium pseudocyst) at a single centre over a 10-year period. We then performed a systematic review and meta-analysis pooling our results with previous studies assessing prenatally diagnosed meconium peritonitis and postnatal outcome. Prenatal sonographic findings were analysed to identify predictors for postnatal surgery.
Results: Thirty-four cases of fetal ultrasound findings suggestive of meconium peritonitis were diagnosed at our center. These were pooled with cases from 14 other studies yielding a total of 244 cases. Postnatal abdominal surgery was required in two thirds (66.5%). The strongest predictor of neonatal surgery was meconium pseudocyst (OR [95% CI] 6.75 [2.53-18.01]; p = 0.000), followed by bowel dilation (OR [95% CI] 4.17 [1.93-9.05]; p = 0.000) and ascites (OR [95% CI] 2.57 [1.07-5.24)]; p = 0.03). The most common cause of intestinal perforation and meconium peritonitis, found in 52.2% of the cases, was small bowel atresia. Cystic fibrosis was diagnosed in 9.8% of the cases. Short term neonatal outcomes were favorable, with a post-operative mortality rate of 8.1% and 100% survival in neonates not requiring surgery.
Conclusion: Meconium pseudocysts, bowel dilation and ascites are prenatal predictors of neonatal surgery in cases of meconium peritonitis. Fetuses with these findings should be delivered in centers with pediatric surgery services. Though prognosis is favorable in general, cystic fibrosis complicates the postnatal outcomes.