Re: amnioscopy
From: james connerth (babydoc@apex.net)
Tue Aug 22 13:04:00 2000
Similar experience-last did one in Miami around 1969-has no place in current
fetal assesment
"O'Grady, Patrick MD" wrote:
> 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 superceded by other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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