Case report and literature review of very echogenic amniotic fluid at term and its clinical significance

The presence of echogenic amniotic fluid on sonography is uncommon and its clinical significance is not well appreciated. Very echogenic amniotic fluid has been attributed to meconium, blood, or vernix caseosa. Two cases of patients with echogenic amniotic fluid at term are presented here. In the first case, the patient's management was altered as the finding of echogenic amniotic fluid was interpreted to be thick meconium. The second case was induced for post-datism and the amniotic fluid was found clear during labour. Since the first reported cases of meconium with echogenic amniotic fluid on sonography by Benacerraf et al. (1984), larger studies have consistently shown that echogenicity is not predictive of meconium. As with our cases, meconium was suspected in both patients with dense echogenic amniotic fluid. Labor was induced in the first case to avoid fetal distress and asphyxia with increasing gestation. Meconium was not present in either of our cases and both the babies were healthy.