Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort
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...
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| creator | Start, Alex O. Ryan, Gillian A. Cathcart, Barbara Hughes, Heather Higgins, Shane Corcoran, Siobhan Walsh, Jennifer Carroll, Stephen Mahony, Rhona Crimmins, Darach Caird, John Colleran, Gabrielle McParland, Peter McAuliffe, Fionnuala M. |
| description | 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 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 20 had higher rates of additional intracranial findings on ultrasound (Vp 20 32/54 (59.3%) (P |
| doi_str_mv | 10.1002/pd.6072 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2607309060</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2620069142</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3452-7b877dc31582941b6a1f0aad793138300d150aadfb6d41396039d4008f679f763</originalsourceid><addsrcrecordid>eNp1kdtq3DAQQEVpaTbb0D8ogj4k0Gw6kryWnbeSNhcINJDm2cjSeOMgXyLZKf6K_nLGu2kfCgGBNNKZw4yGsY8CTgSA_Nq7kxS0fMMWAnK9AinVW7YAQWeVrcUe24_xgcBM5vo921NJpoHWgv25xScMyCscjOdP2A6htqPvGtwYP53y8-1904WydvUwcdO6OaJLio65NRhNQNNyh74m08SDGTBuua6MA84-Mth74z22G3qqW264N2GDvA9d7NEOlMltd0_eD-xdZXzEg5d9ye7Of_w6u1xd_7y4Ovt2vbIqWcuVLjOtnVViTR0lokyNqMAYp3MlVKYAnFjPcVWmLhEqT0HlLgHIqlTnlU7Vkh3tvFTC44hxKJo6WvTetNiNsZD0nQpyoMQl-_wf-tCNoaXqiJIAaS4SSdThjrLUUwxYFX2oGxOmQkAxz6joXTHPiMhPL76xbND94_4OhYAvO-B37XF6zVPcfN_qngEpR5qe</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2620069142</pqid></control><display><type>article</type><title>Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Start, Alex O. ; Ryan, Gillian A. ; Cathcart, Barbara ; Hughes, Heather ; Higgins, Shane ; Corcoran, Siobhan ; Walsh, Jennifer ; Carroll, Stephen ; Mahony, Rhona ; Crimmins, Darach ; Caird, John ; Colleran, Gabrielle ; McParland, Peter ; McAuliffe, Fionnuala M.</creator><creatorcontrib>Start, Alex O. ; Ryan, Gillian A. ; Cathcart, Barbara ; Hughes, Heather ; Higgins, Shane ; Corcoran, Siobhan ; Walsh, Jennifer ; Carroll, Stephen ; Mahony, Rhona ; Crimmins, Darach ; Caird, John ; Colleran, Gabrielle ; McParland, Peter ; McAuliffe, Fionnuala M.</creatorcontrib><description><![CDATA[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).
The data were subdivided into Vp < 20 and Vp > 20 and those with a Vp > 20 had higher rates of additional intracranial findings on ultrasound (Vp < 20 13/41 (31.7%) versus Vp > 20 32/54 (59.3%) (P < 0.05)) and macrocrania (Vp < 20 14/41 (34.1%) versus Vp > 20 35/54 (64.8%) (P < 0.05)). No significant difference was observed in the overall survival or CD rates between the two groups.
Conclusion
In conclusion this study reports significant fetal morbidity and mortality with severe VM with high CD rates observed in this cohort. Significant challenges exist in relation to the obstetric management and counseling of parents regarding an often uncertain neonatal prognosis. In continuing pregnancies with significant macrocrania delivery plans should be individualized to improve neonatal outcomes where possible and minimize harm to the mother.
Key points
What's already known about this topic?
Severe ventriculomegaly is associated with fetal morbidity and mortality
There is paucity of data on the outcomes of Vp > 20 mm versus Vp < 20 mm
There is limited information about caesarean delivery rates of these cases
What does this study add?
The overall survival (excluding TOP) was 71%
No differences were observed in overall survival or CD rates between Vp > 20 mm versus Vp < 20 mm
The overall caesarean delivery rates were 65% in this cohort]]></description><identifier>ISSN: 0197-3851</identifier><identifier>EISSN: 1097-0223</identifier><identifier>DOI: 10.1002/pd.6072</identifier><identifier>PMID: 34870870</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Abnormalities ; Adult ; Atria ; Cerebral ventricles ; Cesarean section ; Cesarean Section - methods ; Cesarean Section - statistics & numerical data ; Chromosome aberrations ; Cohort Studies ; Female ; Fetuses ; Humans ; Hydrocephalus - complications ; Hydrocephalus - epidemiology ; Hydrocephalus - mortality ; Infant, Newborn ; Ireland - epidemiology ; Medical prognosis ; Morbidity ; Mortality ; Neonates ; Obstetrics ; Pregnancy ; Prospective Studies ; Statistical analysis ; Survival ; Ultrasonic imaging ; Ultrasound ; Ventricles (cerebral)</subject><ispartof>Prenatal diagnosis, 2022-01, Vol.42 (1), p.109-117</ispartof><rights>2021 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3452-7b877dc31582941b6a1f0aad793138300d150aadfb6d41396039d4008f679f763</citedby><cites>FETCH-LOGICAL-c3452-7b877dc31582941b6a1f0aad793138300d150aadfb6d41396039d4008f679f763</cites><orcidid>0000-0003-0317-5642</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fpd.6072$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fpd.6072$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34870870$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Start, Alex O.</creatorcontrib><creatorcontrib>Ryan, Gillian A.</creatorcontrib><creatorcontrib>Cathcart, Barbara</creatorcontrib><creatorcontrib>Hughes, Heather</creatorcontrib><creatorcontrib>Higgins, Shane</creatorcontrib><creatorcontrib>Corcoran, Siobhan</creatorcontrib><creatorcontrib>Walsh, Jennifer</creatorcontrib><creatorcontrib>Carroll, Stephen</creatorcontrib><creatorcontrib>Mahony, Rhona</creatorcontrib><creatorcontrib>Crimmins, Darach</creatorcontrib><creatorcontrib>Caird, John</creatorcontrib><creatorcontrib>Colleran, Gabrielle</creatorcontrib><creatorcontrib>McParland, Peter</creatorcontrib><creatorcontrib>McAuliffe, Fionnuala M.</creatorcontrib><title>Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort</title><title>Prenatal diagnosis</title><addtitle>Prenat Diagn</addtitle><description><![CDATA[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).
The data were subdivided into Vp < 20 and Vp > 20 and those with a Vp > 20 had higher rates of additional intracranial findings on ultrasound (Vp < 20 13/41 (31.7%) versus Vp > 20 32/54 (59.3%) (P < 0.05)) and macrocrania (Vp < 20 14/41 (34.1%) versus Vp > 20 35/54 (64.8%) (P < 0.05)). No significant difference was observed in the overall survival or CD rates between the two groups.
Conclusion
In conclusion this study reports significant fetal morbidity and mortality with severe VM with high CD rates observed in this cohort. Significant challenges exist in relation to the obstetric management and counseling of parents regarding an often uncertain neonatal prognosis. In continuing pregnancies with significant macrocrania delivery plans should be individualized to improve neonatal outcomes where possible and minimize harm to the mother.
Key points
What's already known about this topic?
Severe ventriculomegaly is associated with fetal morbidity and mortality
There is paucity of data on the outcomes of Vp > 20 mm versus Vp < 20 mm
There is limited information about caesarean delivery rates of these cases
What does this study add?
The overall survival (excluding TOP) was 71%
No differences were observed in overall survival or CD rates between Vp > 20 mm versus Vp < 20 mm
The overall caesarean delivery rates were 65% in this cohort]]></description><subject>Abnormalities</subject><subject>Adult</subject><subject>Atria</subject><subject>Cerebral ventricles</subject><subject>Cesarean section</subject><subject>Cesarean Section - methods</subject><subject>Cesarean Section - statistics & numerical data</subject><subject>Chromosome aberrations</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Fetuses</subject><subject>Humans</subject><subject>Hydrocephalus - complications</subject><subject>Hydrocephalus - epidemiology</subject><subject>Hydrocephalus - mortality</subject><subject>Infant, Newborn</subject><subject>Ireland - epidemiology</subject><subject>Medical prognosis</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Neonates</subject><subject>Obstetrics</subject><subject>Pregnancy</subject><subject>Prospective Studies</subject><subject>Statistical analysis</subject><subject>Survival</subject><subject>Ultrasonic imaging</subject><subject>Ultrasound</subject><subject>Ventricles (cerebral)</subject><issn>0197-3851</issn><issn>1097-0223</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kdtq3DAQQEVpaTbb0D8ogj4k0Gw6kryWnbeSNhcINJDm2cjSeOMgXyLZKf6K_nLGu2kfCgGBNNKZw4yGsY8CTgSA_Nq7kxS0fMMWAnK9AinVW7YAQWeVrcUe24_xgcBM5vo921NJpoHWgv25xScMyCscjOdP2A6htqPvGtwYP53y8-1904WydvUwcdO6OaJLio65NRhNQNNyh74m08SDGTBuua6MA84-Mth74z22G3qqW264N2GDvA9d7NEOlMltd0_eD-xdZXzEg5d9ye7Of_w6u1xd_7y4Ovt2vbIqWcuVLjOtnVViTR0lokyNqMAYp3MlVKYAnFjPcVWmLhEqT0HlLgHIqlTnlU7Vkh3tvFTC44hxKJo6WvTetNiNsZD0nQpyoMQl-_wf-tCNoaXqiJIAaS4SSdThjrLUUwxYFX2oGxOmQkAxz6joXTHPiMhPL76xbND94_4OhYAvO-B37XF6zVPcfN_qngEpR5qe</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Start, Alex O.</creator><creator>Ryan, Gillian A.</creator><creator>Cathcart, Barbara</creator><creator>Hughes, Heather</creator><creator>Higgins, Shane</creator><creator>Corcoran, Siobhan</creator><creator>Walsh, Jennifer</creator><creator>Carroll, Stephen</creator><creator>Mahony, Rhona</creator><creator>Crimmins, Darach</creator><creator>Caird, John</creator><creator>Colleran, Gabrielle</creator><creator>McParland, Peter</creator><creator>McAuliffe, Fionnuala M.</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7T7</scope><scope>7TK</scope><scope>7TM</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0317-5642</orcidid></search><sort><creationdate>202201</creationdate><title>Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort</title><author>Start, Alex O. ; Ryan, Gillian A. ; Cathcart, Barbara ; Hughes, Heather ; Higgins, Shane ; Corcoran, Siobhan ; Walsh, Jennifer ; Carroll, Stephen ; Mahony, Rhona ; Crimmins, Darach ; Caird, John ; Colleran, Gabrielle ; McParland, Peter ; McAuliffe, Fionnuala M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3452-7b877dc31582941b6a1f0aad793138300d150aadfb6d41396039d4008f679f763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Abnormalities</topic><topic>Adult</topic><topic>Atria</topic><topic>Cerebral ventricles</topic><topic>Cesarean section</topic><topic>Cesarean Section - methods</topic><topic>Cesarean Section - statistics & numerical data</topic><topic>Chromosome aberrations</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fetuses</topic><topic>Humans</topic><topic>Hydrocephalus - complications</topic><topic>Hydrocephalus - epidemiology</topic><topic>Hydrocephalus - mortality</topic><topic>Infant, Newborn</topic><topic>Ireland - epidemiology</topic><topic>Medical prognosis</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Neonates</topic><topic>Obstetrics</topic><topic>Pregnancy</topic><topic>Prospective Studies</topic><topic>Statistical analysis</topic><topic>Survival</topic><topic>Ultrasonic imaging</topic><topic>Ultrasound</topic><topic>Ventricles (cerebral)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Start, Alex O.</creatorcontrib><creatorcontrib>Ryan, Gillian A.</creatorcontrib><creatorcontrib>Cathcart, Barbara</creatorcontrib><creatorcontrib>Hughes, Heather</creatorcontrib><creatorcontrib>Higgins, Shane</creatorcontrib><creatorcontrib>Corcoran, Siobhan</creatorcontrib><creatorcontrib>Walsh, Jennifer</creatorcontrib><creatorcontrib>Carroll, Stephen</creatorcontrib><creatorcontrib>Mahony, Rhona</creatorcontrib><creatorcontrib>Crimmins, Darach</creatorcontrib><creatorcontrib>Caird, John</creatorcontrib><creatorcontrib>Colleran, Gabrielle</creatorcontrib><creatorcontrib>McParland, Peter</creatorcontrib><creatorcontrib>McAuliffe, Fionnuala M.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Prenatal diagnosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Start, Alex O.</au><au>Ryan, Gillian A.</au><au>Cathcart, Barbara</au><au>Hughes, Heather</au><au>Higgins, Shane</au><au>Corcoran, Siobhan</au><au>Walsh, Jennifer</au><au>Carroll, Stephen</au><au>Mahony, Rhona</au><au>Crimmins, Darach</au><au>Caird, John</au><au>Colleran, Gabrielle</au><au>McParland, Peter</au><au>McAuliffe, Fionnuala M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort</atitle><jtitle>Prenatal diagnosis</jtitle><addtitle>Prenat Diagn</addtitle><date>2022-01</date><risdate>2022</risdate><volume>42</volume><issue>1</issue><spage>109</spage><epage>117</epage><pages>109-117</pages><issn>0197-3851</issn><eissn>1097-0223</eissn><abstract><![CDATA[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).
The data were subdivided into Vp < 20 and Vp > 20 and those with a Vp > 20 had higher rates of additional intracranial findings on ultrasound (Vp < 20 13/41 (31.7%) versus Vp > 20 32/54 (59.3%) (P < 0.05)) and macrocrania (Vp < 20 14/41 (34.1%) versus Vp > 20 35/54 (64.8%) (P < 0.05)). No significant difference was observed in the overall survival or CD rates between the two groups.
Conclusion
In conclusion this study reports significant fetal morbidity and mortality with severe VM with high CD rates observed in this cohort. Significant challenges exist in relation to the obstetric management and counseling of parents regarding an often uncertain neonatal prognosis. In continuing pregnancies with significant macrocrania delivery plans should be individualized to improve neonatal outcomes where possible and minimize harm to the mother.
Key points
What's already known about this topic?
Severe ventriculomegaly is associated with fetal morbidity and mortality
There is paucity of data on the outcomes of Vp > 20 mm versus Vp < 20 mm
There is limited information about caesarean delivery rates of these cases
What does this study add?
The overall survival (excluding TOP) was 71%
No differences were observed in overall survival or CD rates between Vp > 20 mm versus Vp < 20 mm
The overall caesarean delivery rates were 65% in this cohort]]></abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34870870</pmid><doi>10.1002/pd.6072</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0317-5642</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0197-3851 |
| ispartof | Prenatal diagnosis, 2022-01, Vol.42 (1), p.109-117 |
| issn | 0197-3851 1097-0223 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2607309060 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Abnormalities Adult Atria Cerebral ventricles Cesarean section Cesarean Section - methods Cesarean Section - statistics & numerical data Chromosome aberrations Cohort Studies Female Fetuses Humans Hydrocephalus - complications Hydrocephalus - epidemiology Hydrocephalus - mortality Infant, Newborn Ireland - epidemiology Medical prognosis Morbidity Mortality Neonates Obstetrics Pregnancy Prospective Studies Statistical analysis Survival Ultrasonic imaging Ultrasound Ventricles (cerebral) |
| title | Severe fetal ventriculomegaly: Fetal morbidity and mortality, caesarean delivery rates and obstetrical challenges in a large prospective cohort |
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