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amnioscopyFrom: O'Grady, Patrick MD (Patrick.OGrady@bhs.org)Tue Aug 22 12:52:52 2000
Amnioscopy has a long and checkered history. The presumed reason for the study was to search for meconium: its presence being accepted as a reason for intervention-- i.e. induction. When I was first a fellow in the 1970's amnioscopy was still popular in some services. I still have in my possession a beautifully milled acrylic amnioscope with a tapered end that was inserted into the cervix and then sidelighted, serving at once the functions of a speculum/lightsource/amnioscope. Alas, this interesting manipulative technique fell from favor once it was appreciated that notation of amniotic fluid volume by RT U/S, maternal fetal movement reports, NST's and/or BPP's were much better methods of estimating fetal risk than simply noting the presence or absence of meconium. I will also add that when the technique was possible to perform, vernix could also easily be seen in the AF by ballottment of the fetal head, causing the AF to be slosh to and fro, moving the yellow/white flecks of vernix like the fake snow in one of those plastic fluid filled globes. This was also a crude measure of fetal maturity, as vernix generally does not appear in the AF until after pulmonic maturity is achieved. Unfortunately, in the patient with a closed cervix the technique was not possible unless you were willing to dilate the cervix in some manner--which was never done in my experience. In those cases, I now blush to recall, we conducted amniocentesis looking for meconium. These days amnioscopy should be relegated to the category of interesting but uninformative tests once thought to provide helpful information but now superceded by other tests (as outlined above) of much higher reliability. J.P. O'Grady, M.D. Baystate Medical Center
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