Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort

Abstract

Introduction:Severe fetal ventriculomegaly (VM) is defined as an enlargement of the atria of the lateral cerebral ventricles (Vp) of greater than 15 mm. While it is well established that it confers significant risk of morbidity and mortality to the neonate, there is limited information pertaining to the caesarean delivery rates and the obstetric management of these complex cases. The aim of this study was twofold: firstly, to determine survival rates in fetuses with severe VM, and secondly to determine the caesarean delivery rates in continuing pregnancies. We explore the obstetric challenges associated with these difficult cases. Methods:This was a prospective observational study of patients with antenatal severe VM, attending the Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland, from 1st January 2011 to 31st July 2020. Data were obtained from the hospital database and those with severe VM (Vp > 15 mm) were identified.The rates of chromosomal abnormalities, the survival rates and the caesarean delivery (CD) rates for the overall group were then determined. The data were then further sub-divided into two groups: 1. Vp < 20 mm and 2. Vp > 20 mm, and the results compared. Statistical analysis was performed using the Chi-Square test.Results: A total of N = 95 pregnancies with severe VM were included for analysis, of which additional structural abnormalities on ultrasound were apparent in 67/95 (70.5%) and 28/95 (29.5%) had isolated severe VM. Chromosomal abnormalities were diagnosed in 15/95 (15.8%) of cases, with (2/28) 7.1% in the isolated SVM group versus (13/67) 19.4% in the non-isolated SVM group. The overall survival rate (excluding TOP) was 53/74 (71.6%), with 20/23 (86.9%) in the isolated SVM group.The overall CD rate was 47/72 (65.3%), which was significantly higher than the CD for the hospital during the same time period of 25.4% (P < 0.01).

Fetal cerebral ventriculomegaly: What do we tell the prospective parents?

“…In severe ventriculomegaly, the cesarean section rate has been reported to be high (>50%). For instance, in a cohort of 72 pregnancies complicated by severe ventriculomegaly (15–20 mm or >20 mm) and macrocrania (head circumference >95th percentile for gestational age), the cesarean section rate was 65.3% 41 . For fetuses with macrocephaly, planned cesarean delivery might be the best option when pelvic‐cephalic disproportion is likely during labor.…”

“…For instance, in a cohort of 72 pregnancies complicated by severe ventriculomegaly (15–20 mm or >20 mm) and macrocrania (head circumference >95th percentile for gestational age), the cesarean section rate was 65.3%. 41 For fetuses with macrocephaly, planned cesarean delivery might be the best option when pelvic‐cephalic disproportion is likely during labor. The use of cephalocentesis is extremely rare and could be reserved for cases of guarded fetal prognosis, to reduce maternal morbidity.…”