{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:30:37Z","timestamp":1772969437275,"version":"3.50.1"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Vernix caseosa peritonitis (VCP) is rare. Nonspecific symptoms of acute abdomen during early puerperium make preoperative diagnosis of VCP challenging. We aimed to identify risk factors, early diagnosis and treatment options, and the association between the timing and severity of VCP diagnosis and maternal outcomes. Materials and Methods: We searched PubMed, PubMed Central, and Google Scholar. Articles were analyzed according to the PRISMA guidelines. The search items included: \u2018vernix caseosa peritonitis, \u2018vernix caseosa granuloma, \u2018maternal meconium peritonitis\u2019, \u2018maternal meconium granuloma\u2019, \u2018vernix caseosa\u2019, \u2018peritonitis\u2019, \u2018pregnancy\u2019, \u2018puerperium\u2019, \u2018postpartum\u2019, and \u2018gravid\u2019. Additional studies were extracted by reviewing the reference lists of retrieved studies. Demographic, clinical, obstetric, diagnostic, and treatment parameters, and outcomes were collected. Results: Out of 55 published VCP case reports, 46 were available. Most involved term pregnancies (84.8%) and were delivered by Cesarean section (CS) (87%), with no difference in parity distribution (\u03c72(2) = 1.1875, p = 0.5523) or fetal sex (m: f = 53.3%: 46.7%). Common symptoms included abdominal pain and fever over 38 \u00b0C, while dyspnea or tachypnea was unexpectedly frequent (23.9%\/15.2%). The interval from delivery to surgery ranged from 4 to 13 days (average 8 days), with no difference between CS and vaginal deliveries. Preoperative VCP was diagnosed in only 4.3% of cases, and intraoperative diagnosis occurred in 60.9%. Intraoperative microbiology and histopathology (vernix components) were positive in 6.5% and 89.1%, respectively. The birth weight was normal (3656 \u00b1 509 g), with no maternal or neonatal deaths. Conclusions: VCP primarily develops in term pregnancies delivered by CS, without other risk factors. Despite extremely low preoperative and unexpectedly low intraoperative diagnosis and treatment delay of several days, there is no maternal or fetal mortality. The time to symptom onset is similar between women who delivered vaginally and those who had a CS. All women with VCP after vaginal delivery had previous deliveries. Abdominal pain with a fever over 38 \u00b0C and dyspnea or tachypnea in the early puerperium suggests VCP. Surgical lavage is the primary treatment, while corticosteroids have been reported to be beneficial in several cases, and antibiotics seem to have a limited role.<\/jats:p>","DOI":"10.3390\/medicina61101786","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T07:57:27Z","timestamp":1759478247000},"page":"1786","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Vernix Caseosa Peritonitis: A Scoping Review"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0202-3324","authenticated-orcid":false,"given":"Goran","family":"Augustin","sequence":"first","affiliation":[{"name":"Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mislav","family":"Herman","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9950-4624","authenticated-orcid":false,"given":"Zrinka","family":"Hrgovi\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Split, 21000 Split, Croatia"},{"name":"Department of Family Medicine, Split-Dalmatia Health Center, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8186-9714","authenticated-orcid":false,"given":"Ante","family":"Kre\u0161o","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital of Split, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7802-599X","authenticated-orcid":false,"given":"Jure","family":"Krstulovi\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Split, 21000 Split, Croatia"},{"name":"Department of Surgery, University Hospital of Split, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Yang, C.H.J., Eykman, E.N., Smith, C.J., Bacon, J., Morris, J.M., Baber, R.J., and Seeho, S.K.M. (2023). Vernix caseosa peritonitis causing acute abdomen after cesarean section: A case series. Am. J. Case Rep., 24.","DOI":"10.12659\/AJCR.938276"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Augustin, G. (2023). Vernix Caseosa Peritonitis. Acute Abdomen During Pregnancy, Springer International Publishing. [3rd ed.].","DOI":"10.1007\/978-3-031-26021-6"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/j.1525-1470.2011.01309.x","article-title":"Neonatal skin maturation\u2014Vernix caseosa and free amino acids","volume":"28","author":"Visscher","year":"2011","journal-title":"Pediatr. Dermatol."},{"key":"ref_4","first-page":"e17953","article-title":"Vernix caseosa peritonitis as a rare cause of acute abdomen after cesarean section","volume":"13","author":"Danawar","year":"2021","journal-title":"Cureus"},{"key":"ref_5","first-page":"e134ms3453","article-title":"Vernix caseosa peritonitis: A case report","volume":"28","year":"2024","journal-title":"Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"221","DOI":"10.4103\/fjs.fjs_53_22","article-title":"Vernix caseosa peritonitis following vaginal delivery: Cheesy peritonitis","volume":"55","author":"Abdullah","year":"2022","journal-title":"Formos. J. Surg."},{"key":"ref_7","first-page":"147","article-title":"Vernix caseosa peritonitis after vaginal delivery","volume":"6","author":"Sadath","year":"2013","journal-title":"Clin. Med. Insights"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1308\/003588412X13373405385296","article-title":"Delayed presentation of vernix caseosa peritonitis","volume":"94","author":"Chambers","year":"2012","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1080\/01443610701582792","article-title":"Vernix caseosa peritonitis","volume":"27","year":"2007","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1093\/ajcp\/103.6.681","article-title":"Vernix caseosa peritonitis: An infrequent complication of cesarean section with distinctive histopathologic features","volume":"103","author":"George","year":"1995","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2572","DOI":"10.1016\/j.radcr.2025.01.087","article-title":"The role of medical imaging in the management of vernix caseosa peritonitis: A case report","volume":"20","author":"Shoung","year":"2025","journal-title":"Radiol. Case Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/1752-1947-3-60","article-title":"Vernix caseosa peritonitis\u2014No longer rare or innocent: A case series","volume":"3","author":"Stuart","year":"2009","journal-title":"J. Med. Case Rep."},{"key":"ref_13","first-page":"1879","article-title":"Maternal vernix caseosa peritonitis: Rare complication of cesarean section","volume":"76","author":"Krumerman","year":"1976","journal-title":"N. Y. State J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1165\/ajrcmb\/1.6.439","article-title":"Cellular and molecular aspects of granulomatous inflammation","volume":"1","author":"Kunkel","year":"1989","journal-title":"Am. J. Respir. Cell Mol. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e262","DOI":"10.1055\/a-2445-7954","article-title":"The collection and application of autologous amniotic fluid to cesarean delivery closure","volume":"14","author":"Grotegut","year":"2024","journal-title":"Am. J. Perinatol. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1001\/jama.1985.03360070086030","article-title":"Maternal vernix caseosa peritonitis following premature rupture of fetal membranes","volume":"254","author":"Schwartz","year":"1985","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1093\/ajcp\/109.3.320","article-title":"Vernix caseosa peritonitis: Report of two cases with antenatal onset","volume":"109","author":"Davis","year":"1998","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.ijsu.2010.07.301","article-title":"Effect of bovine amniotic fluid on intra-abdominal adhesion in male rats","volume":"8","author":"Esmaeili","year":"2010","journal-title":"Int. J. Surg. Lond. Engl."},{"key":"ref_19","first-page":"161","article-title":"Antiadhesive role of human amniotic fluid on peritoneal adhesion formation in a rat model. Experimental study","volume":"58","author":"Hizli","year":"2013","journal-title":"J. Reprod. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.gofs.2019.06.005","article-title":"P\u00e9ritonite \u00e0 vernix caseosa apr\u00e8s accouchement voie basse: Une complication exceptionnelle et m\u00e9connue du post-partum","volume":"47","author":"Cathelain","year":"2019","journal-title":"Gyn\u00e9col Obst\u00e9t Fertil. S\u00e9nol."},{"key":"ref_21","first-page":"3416","article-title":"Abdominal irrigation during cesarean section: Is it beneficial for the control of postoperative pain and gastrointestinal disturbance? A randomized controlled, double-blind trial","volume":"9","author":"Sargin","year":"2016","journal-title":"Int. J. Clin. Exp. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/10\/1786\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T08:20:06Z","timestamp":1759479606000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/10\/1786"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["medicina61101786"],"URL":"https:\/\/doi.org\/10.3390\/medicina61101786","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]}}}