Ultraschall Med 2022; 43(02): 194-203
DOI: 10.1055/a-1194-4363
Original Article

Fetal Meconium Peritonitis – Prenatal Findings and Postnatal Outcome: A Case Series, Systematic Review, and Meta-Analysis

Fetale Mekoniumperitonitis – pränatale Befunde und postnatales Outcome: Eine Fallserie, systematische Übersicht und Metaanalyse
Shiri Shinar
1   Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
,
Swati Agrawal
1   Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
,
Michelle Ryu
2   Sidney Liswood Health Sciences Library, Mount Sinai Hospital Sidney Liswood Health Sciences Library, Toronto, Canada
,
Tim Van Mieghem
1   Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
,
Alan Daneman
3   Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
,
Greg Ryan
1   Obstetrics and gynecology, Mount Sinai Hospital University of Toronto, Toronto, Canada
,
Augusto Zani
4   Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
,
Priscilla Chiu
4   Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
,
David Chitayat
5   Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital Sidney Liswood Health Sciences Library, Toronto, Canada
› Institutsangaben

Abstract

Purpose To describe the postnatal outcome of fetal meconium peritonitis and identify prenatal predictors of neonatal surgery.

Methods We retrospectively reviewed all fetuses with ultrasound findings suspicious for meconium peritonitis at a single center over a 10-year period. A systematic review and meta-analysis were then performed pooling our results with previous studies assessing prenatally diagnosed meconium peritonitis and postnatal outcome. Prenatal sonographic findings were analyzed to identify predictors for postnatal surgery.

Results 34 cases 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 of case (66.5 %). The strongest predictor of neonatal surgery was meconium pseudocyst (OR [95 % CI] 6.75 [2.53–18.01]), followed by bowel dilation (OR [95 % CI] 4.17 [1.93–9.05]) and ascites (OR [95 % CI] 2.57 [1.07–5.24]). 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 cases. Short-term neonatal outcomes were favorable, with a post-operative mortality rate of 8.1 % and a survival rate of 100 % 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 the prognosis is favorable, cystic fibrosis complicates postnatal outcomes.

Zusammenfassung

Ziel Beschreibung des postnatalen Outcomes der fetalen Mekoniumperitonitis und Identifizierung pränataler Prädiktoren für die neonatale Chirurgie.

Methoden Wir untersuchten an einem einzigen Zentrum über 10 Jahre hinweg retrospektiv alle Föten mit Ultraschallbefunden, bei denen der Verdacht einer Mekoniumperitonitis bestand. Eine systematische Übersicht und eine Metaanalyse wurden daraufhin durchgeführt, um unsere Ergebnisse mit früheren Studien zur Beurteilung der pränatalen Mekoniumperitonitis und des postnatalen Outcomes zusammenzufassen. Die pränatalen sonografischen Befunde wurden analysiert, um Prädiktoren für die postnatale Chirurgie zu identifizieren.

Ergebnisse In unserem Zentrum gab es 34 Fälle mit Verdachtsdiagnose Mekoniumperitonitis. Diese wurden mit Fällen aus 14 anderen Studien zusammengefasst, sodass sich insgesamt 244 Fälle ergaben. In 2 Drittel der Fälle (66,5 %) war eine postnatale abdominale Operation erforderlich. Der stärkste Prädiktor für die neonatale Chirurgie war eine Mekonium-Pseudozyste (OR 6,75; 95 %-KI 2,53–18,01), gefolgt von Darmdilatation (OR 4,17; 95 %-KI 1,93–9,05) und Aszites (OR 2,57; 95 %-KI 1,07–5,24). Die häufigste Ursache für Darmperforation und Mekoniumperitonitis, die in 52,2 % der Fälle gefunden wurde, war die Dünndarmatresie. Mukoviszidose wurde in 9,8 % der Fälle diagnostiziert. Das Kurzzeit-Outcome bei Neugeborenen war günstig, mit einer postoperativen Mortalitätsrate von 8,1 % und einer Überlebensrate von 100 % bei Neugeborenen, die nicht operiert werden mussten.

Schlussfolgerung Mekonium-Pseudozysten, Darmdilatation und Aszites sind pränatale Prädiktoren für eine neonatale Chirurgie bei Mekoniumperitonitis. Bei Föten mit diesen Befunden sollte die Entbindung in Zentren mit dem Schwerpunkt Neugeborenenchirurgie erfolgen. Obwohl die Prognose günstig ist, erschwert Mukoviszidose das postnatale Outcome.



Publikationsverlauf

Eingereicht: 31. Januar 2020

Angenommen: 27. Mai 2020

Artikel online veröffentlicht:
23. Juni 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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