A total of 34 prenatally diagnosed cases of meconium peritonitis, including one personal and 33 reported cases, are reviewed retrospectively. Of these 34, meconium peritonitis was diagnosed by workup for obstetric fetomaternal problems in 23, by regular ultrasound examinations in 10, and by routine checkup preceding pregnancy termination. In addition to intraabdominal calcification and intestinal dilatation, fetal ascites, abdominal cyst and abdominal mass were sonographically revealed in 17, 5, and 5 cases, respectively. Four of these antenatally diagnosed fetuses underwent abdominal paracentesis, and another 3 were delivered by cesarean section. Previous reports show that none of those cases detected before the 26th week of gestation could survive after birth. Based on these results, a systematic approach to obstetrical management of fetuses with meconium peritonitis is outlined as follows. First, fetal paracentesis should be conducted in an attempt to ensure an adequate pulmonary growth when a developement of fetal ascites results in a rapid increase of the abdominal circumference before the 28th week of gestation. Secondary, elective preterm cesarean section could be justified to improve the operative outcome after 28 weeks of gestaion or once fetal lung maturity is obstetrically considered adequate.
