Amniography in prenatal diagnosis

Diagnosis of ruptured fetal membranes in pregnancy with the use of urograffin

The objective of our study was to assess the value of intraamniotic injection of urograffin in the diagnosis of premature rupture of membranes (PROM). Intra-amniotic injection of urograffin with the concomitant insertion of a vaginal tampon was performed in 30 consecutive patients who were admitted because of suspected PROM and the presence of a heavy bloody vaginal secretion. The vaginal tampons were X-rayed for the presence of radio-opacity. In 23 patients, traces of urograffin were found in the vaginal tampons by X-ray. No fetal or maternal complications were observed during delivery and puerperium. We suggest the use of intraamniotic injection of urograffin for the diagnosis of PROM in cases where heavy bloody vaginal discharge is present.

Meckel Syndrome

Meckel syndrome is a rare, lethal, genetic disorder that can be diagnosed sonographically. Five cases of Meckel syndrome were sonographically observed prenatally between 18 and 33 weeks. In all five cases, the fetal kidneys were large and echogenic. Two of four fetuses with encephaloceles were correctly identified sonographically, and two of four fetuses with polydactyly were identified with ultrasound. Major sonographic findings in 24 previously reported cases are reviewed. Differential diagnoses are also discussed. In any fetus with large, echogenic kidneys, one should suspect Meckel syndrome and should search for the other associated abnormalities, chiefly, encephalocele, polydactyly, hydrocephalus, and cleft lip and palate.

Prenatal diagnosis of Meckel syndrome: case reports and literature review

We report on 2 couples at risk to have Meckel syndrome (MS) offspring. Three pregnancies were monitored by ultrasonography and alpha-fetoprotein (AFP) assay in midtrimester. Of the 2 involving an affected fetus, one was thought to be unaffected. A literature survey was undertaken. Sources of error seem to lie in the heterogeneity of clinical manifestations and the variable onset and rate of progression of clinical components of MS and limitations in ultrasonographic resolution inherent in the scanner or due to the associated oligohydramnios. The following observations/suggestions are made concerning the prenatal diagnosis of MS: 1) Utilize as many tests as are available. 2) Amniotic fluid AFP is more likely to show significant elevation than serum AFP. 3) Ultrasonography should concentrate on presence of oligohydramnios, small head diameter, cystic mass at the occiput, large kidneys, and absent bladder. 4) Use serial AFP and sonographic examination if findings are initially normal or equivocal.