Clinical significance and prognosis of asymmetric ventricles in fetuses

Abstract

Objective To investigate the clinical significance and prognosis of ultrasound-identified asymmetric ventricles in fetuses, and to provide evidences for clinical consultation and management. Methods From January 2014 to May 2017, 142 singleton fetuses were enrolled who were diagnosed with asymmetric ventricles through prenatal ultrasound in Peking University First Hospital and successfully followed up after birth. Asymmetric ventricles included simple lateral ventricular asymmetry [lateral ventricular widths were normal (<10 mm) but with a difference of ≥2 mm between the two lateral ventricles and unilateral ventricular widening (only one lateral ventricle was ≥10 mm in width and the other was <10 mm). All 142 fetuses were divided into two groups according to whether they had other abnormalities (including abnormal ultrasound soft markers and structural abnormalities) or not. Clinical and imaging data of them were analyzed retrospectively. They were followed up for at least six months after birth. Neurological development regarding language, behavior and motor was evaluated using Denver Developmental Screening Test. Results There were 109 cases without other abnormalities and among them, 38 (35%) spontaneously recovered in utero, two (2%) became worse, and 69 (63%) remained unchanged. Thirty-one of the 109 cases received fetal cranial MRI and abnormal brain development was found in only one case. No abnormal findings were reported in karyotyping in 38 cases and viral detection in 31 cases. One hundred and five fetuses were successfully delivered and four were induced including two cases for wider in unilateral lateral ventricle, one of continued widening, and one with abnormal brain development suggested by fetal cranial MRI. Among the 33 cases with other abnormalities, two were spontaneously recovered in utero, one became worse , 15 unchanged and 15 were induced. Of the 20 cases underwent chromosomal examination, one unbalanced chromosome translocation was identified. Twelve fetuses underwent cranial MRI among which two were found abnormal (periventricular cyst and brain asymmetry). Sixteen cases were aborted including 15 with major abnormalities (major deformity or absence of extremities) and one with mild abnormality (abnormal ultrasound soft markers with progression in lateral ventricular width ≥15 mm in in-utero follow-up). Seventeen cases were born including 16 with mild abnormalities and one with severe abnormality (unilateral renal cystic disease without chromosome abnormality). No significant developmental abnormality in language, behavior and motor was reported during follow-up. Conclusions Asymmetric ventricles have no significant impact on fetal growth and postnatal development. The prognosis of asymmetric ventricles mainly depends on the width of lateral ventricles in utero and concomitant abnormalities. Therefore, close attention should be paid on monitoring and follow-up. Key words: Hydrocephalus; Lateral ventricles; Ultrasonography, prenatal; Prognosis