Re: Counseling in isolated mild fetal ventriculomegaly

Abstract

We read with interest the paper by Melchiorre et al.1. The authors aimed at providing up-to-date and evidence-based answers to common questions regarding isolated mild fetal ventriculomegaly. One of the recent concerns regarding ventriculomegaly is whether the fetal lateral ventricular atrium measuring between 10 and 12 mm is simply a variation of the norm2. Using pooled data from previous studies, Melchiorre et al. concluded that there was no significant difference in the incidence of abnormal neurological outcome between the groups with atrial width 10.0–11.9 mm and 12.0–15.0 mm, the incidence being 12% and 16%, respectively. We are concerned that this conclusion might have been incorrect for the following reasons. First, there was an error in data extracted from the study by Ouahba et al.3, who explicitly reported that the rate of children having a neurological disease and with an atrial width between 12 and 15 mm was 24.2% (8/33), significantly higher than the rate of 5.9% (4/68) when the atrial width was between 10 and 12 mm. These incidences were incorrectly quoted as 28% and 33% by Melchiorre et al.1. Second, there are two recent articles which were not included in the review4, 5. When data from these two studies are included for analysis, together with the correct data from Ouahba's study3, there is actually a significant difference in abnormal neurological outcome in these two groups (Table 1): 16/90 (17.8%) fetuses with atrial width 12–15 mm vs. 20/330 (6.1%) fetuses with atrial width 10–12 mm (relative risk, 2.07; 95% CI, 1.38–3.12; P = 0.002). This abnormal neurological outcome for the group with ventriculomegaly between 10 and 12 mm is approximately half that reported by Melchiorre et al.1. We believe that this supplementary information is important in assisting clinicians to provide a more reassuring prognosis to the couple whose fetus is noted to have ventriculomegaly between 10 and 12 mm. L. W. Chan*, T. K. Lau*, * Fetal Medicine Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong