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Nonimmune Hydrops Fetalis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Chelsea DeBolt, Katherine Connolly, Mary E. Norton, Joanne Stone
The primary gastrointestinal abnormalities that have been associated with NIH are diaphragmatic hernia, midgut volvulus, obstruction, jejunal atresia, malrotation of the intestines, and meconium peritonitis [4, 15]. Gastrointestinal obstruction may lead to NIH due to decreased colloid osmotic pressure from protein loss [15]. Intestinal perforation produces variable degrees of ascites (meconium peritonitis) not easy to differentiate from other forms of intra-abdominal serum effusion. The presence of meconium seen as bright plaques or echo-poor cystic areas should lead to the diagnosis even in absence of dilated bowel. When meconium peritonitis is not associated with generalized hydrops, the prognosis is good. Meconium peritonitis may be associated with cystic fibrosis and a workup for this disorder is suggested. Prenatal causes of bowel obstruction are atresia (“apple-peel” syndrome) and volvulus. Intraabdominal masses may cause NIH due to obstruction of venous return. Hemangioma of the liver has also been associated with NIH, likely due to arterio-venous shunting leading to high output cardiac failure [1]. Other hepatic disorders, such as cirrhosis, biliary atresia, hepatic hamartomas, and polycystic disease have also been associated with NIH, likely as a result of hypoproteinemia [1].
Abdominal Echogenicity
Published in Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan, Problem-Based Obstetric Ultrasound, 2019
Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan
Echogenic bowel is the most common echogenic mass in the fetal abdomen. By definition the bowel is considered echogenic only if it is as bright as or brighter than the adjacent bone, namely, the iliac crest. The most common cause for echogenic bowel is fetal ingestion of blood cells. This is usually identified as floating particles in the amniotic fluid and is backed by history of vaginal bleeding. In the absence of any other markers for chromosomal markers or structural abnormalities, this isolated finding is unlikely to increase the risk for chromosomal abnormalities in a previously screened population, however, further screening options such as non-invasive prenatal tests and invasive diagnostic tests may be offered to the patient. The presence of associated bowel dilatation with or without ascitic fluid should raise the possibility of meconium peritonitis. This occurs when there is perforation of the bowel in utero and causes chemical peritonitis. This may be due to meconium ileus, and the couple should be offered screening for cystic fibrosis. Other causes are bowel atresia or volvulus, and these will be associated with bowel dilatation, which might manifest later on in the pregnancy.
Neonatal and General paediatric Surgery
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
The plain abdominal x-ray shows dilated loops of intestine of varying calibre (Fig. 18.9) and, unless there is an atresia or volvulus, an absence of air–fluid levels. Calcification indicates the prior occurrence of an intestinal perforation. A ‘ground-glass’ appearance of impacted meconium may be seen on the plain x-ray. In meconium peritonitis, the abdomen may be opaque due to the presence of ascites.
Fetal hydrops – a review and a clinical approach to identifying the cause
Published in Expert Opinion on Orphan Drugs, 2020
Esther Dempsey, Tessa Homfray, John M Simpson, Steve Jeffery, Sahar Mansour, Pia Ostergaard
Gastrointestinal causes are included in most etiology reports of nonimmune fetal hydrops. However, they make up a small percentage of all cases and there are a limited number of case reports. Meconium peritonitis results from the rupture of the fetal bowel and the leak of meconium into the peritoneal space. The inflammation that ensues appears as calcifications on the fetal ultrasound and dilated bowel loops. It is seen more frequently in fetuses with cystic fibrosis although it is still a rare complication. Meconium peritonitis usually causes ascites, but this has been shown to cause a more severe presentation of hydrops [165]. Any cause of bowel infarction and resultant fluid loss into the peritoneal cavity (stenosis, atresia, volvulus, peritoneal bands, imperforate anus, intussusception) can cause edema as a result of the reduced vascular colloid osmotic pressure [9].
Prenatal diagnosis and prognosis assessment of fetal intra-abdominal cystic lesions: a retrospective study in 264 cases
Published in Journal of Obstetrics and Gynaecology, 2019
Min Lv, Baihui Zhao, Qiong Luo
There were four postpartum deaths, of all, which had been given prenatal recommendations for the intervention. One had meconium peritonitis and died one week after birth. One had an intestinal obstruction, and an operation was attempted to be performed, but the neonate died 10 days after birth. Other case had adrenal neuroblastoma and died three months after birth. The final case was prenatally diagnosed as having an urachal cyst, which was postnatally determined to be acromphalus, ureter obstruction and hydronephrosis; this neonate’s family refused further treatment after birth (Table 1).
Massive ascites and severe pulmonary hypoplasia in a premature infant with meconium peritonitis and congenital cytomegalovirus infection
Published in Fetal and Pediatric Pathology, 2020
Meconium peritonitis (MP) is an aseptic chemical peritonitis, caused by perforation in the fetal bowel wall and subsequent spillage of meconium into the fetal abdominal cavity. Meconium, being a strong proinflammatory mediator, triggers an inflammatory response within the fetal abdominal cavity, resulting in ascites and calcifications. Meconium pseudocyst may form when a mass of meconium is walled off by a calcific rim [1]. There are several potential causes of fetal bowel wall perforation in utero, including intestinal atresia, volvulus, and cystic fibrosis.