Epidemiology, Natural History, Progression, and Postnatal Outcome of Severe Fetal Ventriculomegaly

ArticleinObstetrics and Gynecology 120(6):1345-53 · December 2012with17 Reads
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.
    • "Therefore, it is important to carry out a systematic physical examination of the gender, head circumference, width of the ventricles and karyotype. According to Hannon et al. [12], the incidence of the major forms of ventriculomegaly is 3.6 per 10,000 births. In nearly 50% of our cases, the pregnancy was terminated for medical reasons, and a 21% neonatal lethality was found for live births, half of whom presented with an isolated hydrocephalus. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jul 2014
  • [Show abstract] [Hide abstract] ABSTRACT: IntroductionThe finding of fetal ventriculomegaly is variably associated with other fetal abnormalities and, even when isolated, thought to be linked to abnormal neurodevelopmental outcome. The aim of this study was to undertake a systematic review and meta-analysis of the current literature to assess the prevalence of neurodevelopmental delay in cases of isolated mild fetal ventriculomegaly, and 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 outcome in isolated ventriculomegaly were identified from a search of scientific databases. Studies that did not check for karyotype or that excluded cases of bilateral ventriculomegaly were not included in the analysis. Ventriculomegaly was defined as mild when the ventricular width was between 10 and 15 mm. Cases in which an associated abnormality (abnormal karyotype, structural abnormality or fetal infection) was observed either prior 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. ResultsThe 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, and a total of 20 studies were included in the review with a total of 699 cases of isolated mild ventriculomegaly. The overall prevalence of neurodevelopmental delay was 7.9% (95% CI 4.7-11.1%). Out of the 20 studies included in SR, nine reported systematically data about post-natal imaging showing a prevalence of previously undiagnosed findings of 7.4% (95% CI 3.1-11.8%). Conclusions The false negative rate of prenatal imaging is 7.4% in apparently isolated fetal ventriculomegaly ≤15 mm. The incidence of neurodevelopmental delay in truly isolated ventriculomegaly ≤15 mm is 7.9%. As the latter rate is in keeping with that noted in the general population, large prospective cohort studies assessing the prevalence of childhood disability rather than subtle neurodevelopmental delay are required.
    Full-text · Article · Oct 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Objetives To determine the prevalence of fetal ventriculomegaly and identify the neurological outcomes of newborns with a prenatal diagnosis. Method Observational study of ventriculomegaly prenatally diagnosed by ultrasound in our department between 2004 and 2012. Results We diagnosed 61 cases of ventriculomegaly. The prevalence rate was 2.25 per 1,000. Diagnosis was made during the second trimester in 54 patients and during the third trimester in 7. Bilateral ventriculomegaly was found in 91% of the fetuses. Ventriculomegaly was mild (10-12 mm) in 79.4% and moderate (12-15 mm) in 5.6%. Severe ventriculomegaly (>15 mm) or hydrocephalus was diagnosed in 15% of the fetuses. The clinical course during pregnancy was unfavorable in 13%. Associated anomalies were diagnosed in 23 cases. Conclusions Mild, isolated and non-progressive ventriculomegaly has the best neurological prognosis.
    Article · May 2014
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