Epidemiology, natural history, progression, and postnatal outcome of severe fetal ventriculomegaly.

Fetal Medicine Unit, the Royal Victoria Infirmary, and the Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, United Kingdom.
Obstetrics and Gynecology (Impact Factor: 4.37). 12/2012; 120(6):1345-53. DOI: 10.1097/AOG.0b013e3182732b53
Source: PubMed

ABSTRACT : To estimate the prevalence, associated anomalies, progression, and clinical outcome in fetuses prenatally diagnosed with severe ventriculomegaly.
: This is a population-based study using prospectively collected data from the north of England. Data were obtained from the Northern Congenital Abnormality Survey for the period 1994-2008. Associated anomalies were categorized using the European Surveillance of Congenital Anomalies guidelines. Differences between isolated and nonisolated ventriculomegaly were examined using Fisher's exact test or Mann-Whitney U test.
: There were 157 cases of confirmed severe ventriculomegaly in singleton pregnancies among 441,247 eligible births, a prevalence of 3.6 per 10,000 births (95% confidence interval [CI] 3.0-4.2). Chromosomal anomalies were detected prenatally in five cases (3.2%, 95% CI 1.0-7.3) and associated structural anomalies in 67 (42.7%, 95% CI 34.8-50.8). One hundred one women (64.3%) elected to have a termination of pregnancy, more commonly in the presence of associated anomalies (76.9% compared with 51.9%, P=.001). Ultrasonographic follow-up data were available for 53 fetuses; in 13 cases (24.5%), atrium size decreased prenatally, whereas in the remainder, median atrium size increased by 4.1 mm over 3.5 weeks. Associated anomalies were detected postnatally in 22 of 79 cases suspected prenatally to be isolated (27.8%, 95% CI 18.3-39.1). Of 53 live births, there were 11 (20.8%) neonatal deaths, including six (16.2%) of the isolated group. Neonatal death was not predicted by atrial measurement progression.
: The prevalence of severe ventriculomegaly was 3.6 per 10,000 births. Although more than 50% opt to terminate, of those with live births, there were 21% neonatal deaths with nearly half in neonates with isolated ventriculomegaly.
: III.

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    ABSTRACT: Objectives The finding of fetal ventriculomegaly is vari-ably associated with other fetal abnormalities and, even when isolated, is thought to be linked to abnormal neuro-developmental outcome. The aim of this study was to undertake a systematic review and meta-analysis of the current literature to assess the prevalence of neurodevel-opmental delay in cases of isolated mild fetal ventricu-lomegaly, as well as the false-negative rate of prenatal imaging for the diagnosis of associated abnormalities in patients referred for isolated mild ventriculomegaly. Methods Studies that assessed neurodevelopmental out-come in isolated ventriculomegaly were identified from a search of scientific databases. Studies that did not check for karyotype or that excluded cases of bilateral ven-triculomegaly were not included in the analysis. Ventricu-lomegaly was defined as mild when the width of the ven-tricular atrium was between 10 and 15 mm. Cases in which an associated abnormality (abnormal karyotype, structural abnormality or fetal infection) was observed either before or after birth were not considered as part of the isolated group. Neurodevelopmental delay was defined as an abnormal quotient score, according to the test used. Results The search yielded 961 possible citations; of these, 904 were excluded by review of the title or abstract as they did not meet the selection criteria. Full manuscripts were retrieved for 57 studies, and 20 were included in the review with a total of 699 cases of isolated mild ventricu-lomegaly. The overall prevalence of neurodevelopmental delay was 7.9% (95% CI, 4.7–11.1%). Of the 20 stud-ies included in the systematic review, nine reported data on postnatal imaging, showing a prevalence of previously undiagnosed findings of 7.4% (95% CI, 3.1–11.8%). Conclusions The false-negative rate of prenatal imag-ing is 7.4% in apparently isolated fetal ventriculomegaly of ≤ 15 mm. The incidence of neurodevelopmental delay in truly isolated ventriculomegaly of ≤ 15 mm is 7.9%. Accepted: 26 February 2014 As the latter rate is similar to that noted in the general population, large prospective cohort studies assessing the prevalence of childhood disability, rather than subtle neu-rodevelopmental delay, are required. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
    Ultrasound in Obstetrics and Gynecology 03/2014; · 3.56 Impact Factor
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    ABSTRACT: Abstract: The aim of this study was to draw the attention of specialists faced with fetal hydrocephalus in the postnatal period to the possibilities of prenatal diagnosis and further monitoring by studying isolated and syndrome cases in fetuses. One hundred and nine fetuses from a total of 2238 autopsies were the subject of observation in this study. In 64 (58.7%) of the studied fetuses, isolated hydrocephalus was found, while the other 45 cases were associated with the following malformations: ArnoldChiari type II, Dandy-Walker, stenosis of the aqueductus sylvii, agenesis of corpus callosum (partial and total) and numerical chromosomal aberrations such as trisomy 13, 15 and 18. In cases of isolated hydrocephalus and a stable condition of the fetus, it is possible to wait until the term, or to induce labor without danger to the child, followed by a shunting intervention.
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    ABSTRACT: Objective This study aims to determine the incidence, etiology, diagnostic criteria and early outcomes of prenatally diagnosed fetal ventriculomegaly (VM). Methods Diagnostic criteria for the fetal VM was atrial diameter of lateral ventricle measuring ≥10 mm, independent from gestational age. Results of our patients from ultrasonography (USG), karyotyping, congenital infections, and associated abnormalities were noted. Progress during pregnancy, postnatal USG results and neurobehavioral outcomes were recorded. Results In our study, 40 subjects of fetal VM were recorded. 16 and 24 of those were bilateral (40%) and unilateral (60%) respectively. Female to male fetus ratio was 19/21 (0.9). Median gestational age at the diagnosis was 22 weeks (ranging between 16 and 34 weeks). While 21 VM subjects were isolated (52.5%) only 19 of the total were shown associated structural abnormalities in (47.5%) in addition to VM. Toxoplasmosis were diagnosed only in one subject (2.5%). Nineteen subjects had amniocentesis (47.5%) and 2 of them were showed abnormalities (10.5%) as follows; “inversion and duplication 8 (p11.2p23)” and “deletion 3”. VM got back in to normal size during pregnancy in 24 subjects (24/40, 60%). Eight pregnancies were terminated (8/40) (20%). Five babies passed away during neonatal and postneonatal period. Some other structural abnormalities were diagnosed after the birth at six babies who classified as mild “isolated” VM. Conclusions Our study revealed that amongst mild VM subjects, incidence of associated abnormalities and termination rate were higher. Although most of mild VM subjects are thought to be benign, associated abnormalities should be carefully evaluated and determined pre- and postnatally.
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