Clinical outcomes of 241 cases with fetal ventriculomegaly

Abstract

Objective To evaluate the pregnancy outcomes and prognosis of fetuses with different levels of ventriculomegaly. Methods Fetuses with ventriculomegaly subjected to the multidisciplinary consultation in the Obstetrics and Gynecology Hospital of Fudan University between January 2004 and December 2013 were included in this study. The fetuses were divided into three groups according to the width of the lateral ventricles on ultrasound examination as follows: mild ventriculomegaly (Mild Group, ≥10 - <12 mm, 151 cases), moderate ventriculomegaly (Moderate Group, ≥12 - <15 mm, 56 cases) and severe ventriculomegaly (Severe Group, ≥15 mm, 34 cases). All cases were followed up with additional ultrasound scans during pregnancy and follow-up was continued until the children were almost nine years old. Chi-square test, Fisher's exact test and Bonferroni method were used to analyze the data. Results Two hundred and forty one fetuses were followed up. Ninety-one cases were terminated, and 150 were born (105 cases in Mild Group, 30 cases in Moderate Group, and 15 cases in Severe Group). During ultrasound follow-up of the 150 cases, the lateral ventricle width regressed in 42 cases (28.0%) and remained stable in 108 cases (72.0%). In the regressed group, the ventricle width in 31 cases in the Mild Group regressed to normal and a hearing abnormality was noted in one case after birth. In the Moderate Group, the lateral ventricle width in nine cases regressed to normal, one case had mild ventriculomegaly, and none of these cases showed abnormalities after birth. One case in the Severe Group showed no abnormalities, while the width of the lateral ventricles decreased to 14.0 and 16.0 mm. With regard to the outcomes of lateral ventricle width with or without regression, one of 42 cases in the regressed group had a significant abnormality, while 19 of 108 cases in the stable group [eleven cases (14.9%, 11/74) in Mild Group, two (10.9%, 2/20) in Moderate Group, and six (6/14) in Severe Group] showed significant abnormalities. Statistically significant differences were found between the two groups [2.4%(1/42) vs 17.6%(19/108), χ2=4.940, P=0.026]. When the outcomes of the three groups were compared, 12 of 105 cases in the Mild Group (11.4%), two of 30 cases in the Moderate Group (6.7%), and 6 of 15 cases in the Severe Group (6/15) had significant abnormalities. Statistically significant differences were found between the three groups (χ2=6.908, P=0.032). Statistical significance was observed in the Moderate Group and Severe Group (χ2=4.929, P=0.026), while the Mild Group had a more favorable prognosis than the Severe Group (χ2=5.266, P=0.022). Chromosomal examinations were carried out in 57 cases and the incidence of chromosomal abnormalities was 8.8%(5/57) [7.0% (3/43), 1/8 and 1/6 in the three groups, respectively]. Infection screening was performed in 29 cases and one case was found to be positive for rubella virus-IgM, two cases were positive for cytomegalovirus-IgM, and one case was positive for toxoplasma gondii-IgM. Conclusions Pregnancy outcomes and the prognosis of fetal ventriculomegaly are associated with the degree and progression of ventricular dilatation. Key words: Ultrasonography, prenatal; Hydrocephalus; Pregnancy outcome; Follow-up studies