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Re: Meconeum stainFrom: Paula S. Woletz, RDMS, RDCS, MPH (pwoletz@lycos.com)Sat Jun 2 13:34:23 2001
At Mon, 28 May 2001, Belal Hossain wrote: > >Is it possible to diagnose meconeum stained liq by usg? If yes,what could be the finding over a b/w monitor? >yours etc, >Dr Belal Hossain,MD >Kolaghat.India > Dear Dr. Hossain, Unfortunately, ultrasound has not been successful in identifying meconium in amniotic fluid. See below. Regards, Paula Woletz 1: J Clin Ultrasound 1998 May;26(4):191-3 Clinical significance of echogenic amniotic fluid. Petrikovsky B, Schneider EP, Gross B. Division of Maternal Fetal Medicine, North Shore University Hospital, New York University School of Medicine, Manhasset 11030, USA. PURPOSE: This study aimed to determine the clinical significance of echogenic amniotic fluid. METHODS: We prospectively studied 19 twin pregnancies in which the amniotic fluid in 1 sac was anechoic and that in the other sac was echogenic. Morphologic characteristics of amniotic fluid were assessed from samples taken at amniocentesis or upon delivery within 48 hours after sonographic examination. RESULTS: In twins with echogenic amniotic fluid, assessment revealed clear fluid in 6 cases (32%), vernix caseosa in 12 (63%), and meconium in 1 (5%). In co-twins with anechoic amniotic fluid, assessment revealed clear fluid in 9 cases (47%), vernix caseosa in 6 (32%), and meconium in 4 (21%). CONCLUSIONS: Echogenic amniotic fluid on prenatal sonography is not predictive of meconium. PMID: 9572381 [PubMed - indexed for MEDLINE] 2: J Ultrasound Med 1994 Feb;13(2):95-7 Very echogenic amniotic fluid: ultrasonography-amniocentesis correlation. Brown DL, Polger M, Clark PK, Bromley BS, Doubilet PM. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115. Very echogenic amniotic fluid has been variably attributed to meconium, blood, or vernix caseosa. However, most previous reports have been case reports, and most cases have not had proof by amniocentesis. In a larger series of patients with proof by amniocentesis, we sought to determine the relative frequency of these substances as causes of very echogenic amniotic fluid. We retrospectively identified obstetric sonograms in which the amniotic fluid was homogeneously filled with innumerable echogenic particles. The cause of the increased echogenicity was determined by fluid appearance at amniocentesis. Of 86 cases identified, immediate proof by amniocentesis was available in 19 patients for whom the gestational age ranged from 32.8 to 39.4 weeks. Vernix was present in 18 (95%) patients and meconium in one (5%) patient. Very echogenic amniotic fluid in the third trimester is most often due to vernix and infrequently due to meconium. This sonographic finding is not a reliable indicator of meconium or blood in amniotic fluid and should not typically alter antenatal management. PMID: 7932968 [PubMed - indexed for MEDLINE] 3: Obstet Gynecol 1991 Nov;78(5 Pt 1):819-22 Sonographically homogeneous echogenic amniotic fluid in detecting meconium-stained amniotic fluid. Sherer DM, Abramowicz JS, Smith SA, Woods JR Jr. Department of Obstetrics and Gynecology, Strong Memorial Hospital, Rochester, New York. A prospective study was performed to examine the hypothesis that sonographically homogeneous echogenic amniotic fluid (AF) may provide a marker for the presence of meconium-stained AF. Twenty term gestations in which homogeneous echogenic AF was demonstrated sonographically were compared with 40 cases with sonographically clear AF. Two cases in the study group had meconium-stained AF at delivery. All of the controls had clear fluid by amniocentesis (performed for lung maturation studies) immediately after the sonographic examination. Thus, homogeneous echogenic AF had a sensitivity of 100%, a specificity of 69%, a positive predictive value of 10%, and a negative predictive value of 100% in detecting meconium. We conclude that homogeneous echogenic AF does not necessarily detect meconium-stained AF. PMID: 1923205 [PubMed - indexed for MEDLINE] 4: J Perinat Med 1989;17(5):333-5 Sonographic detection of echogenic amniotic fluid and its clinical significance. Sepulveda WH, Quiroz VH. Department of Obstetrics and Gynecology, Guillermo Grant Benavente Hospital, Concepcion, Chile. It has been suggested that meconium-stained amniotic fluid can be detected in the antepartum period by means of ultrasound, based on the following findings: (1) a diffuse echogenic pattern throughout the amniotic cavity, (2) a clear contrast between the amniotic fluid and the umbilical cord, and (3) layering in the more dependent areas. Reported is a case in which a similar picture was obtained in a third trimester, high-risk pregnancy, but representing vernix instead of meconium. We are aware of six cases, including ours, of sonographic detection of echogenic amniotic fluid. The review of these cases indicates that the findings refer more often to a considerable amount of vernix rather than meconium, and it is not necessarily associated with postmaturity. If echogenic amniotic fluid is identified in an obstetrical ultrasound, we recommend: (1) rule-out meconium by amniocentesis or amnioscopy, or (2) study fetal well-being by means of nonstress test and/or biophysical profile. Thus, a false positive diagnosis of fetal distress in these cases could be easily avoided. PMID: 2696778 [PubMed - indexed for MEDLINE]
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