The natural history of moderate-severe ventriculomegaly: A review of cases managed expectantly in an Irish tertiary Centre

Introduction: Prenatal counselling for cerebral ventriculomegaly is challenging due to varied factors and prognoses. There is limited data about the natural history of affected pregnancies managed expectantly. We sought to review the prenatal course, obstetric and paediatric outcomes in cases of moderate to severe cerebral ventriculomegaly in an Irish tertiary maternity unit. Materials and methods: Retrospective review of patients attending the Fetal Assessment Unit from 2006-2014 with lateral cerebral ventricular measurements >12 mm on ultrasound. Results: During the nine-year period, 93 cases were identified with pregnancy outcome data available for 80 cases and 54 continuing in our institution. Vaginal delivery was achieved in 28.9% of women with 71.1% undergoing caesarean. There were 9 cases of intrauterine demise and an additional six neonatal deaths and three paediatric deaths. An isolated neural tube defect was present in 12 babies. Of the remaining 33 babies a diagnosis was confirmed in 60.6% of which, 45% were achieved antenatally. Conclusions: A diagnosis was obtained in 70% of live births. The presence of ventriculomegaly had a significant impact on the mode of delivery and maternal morbidity. The survival rate was 66.6% with high rate of neurodevelopmental delay recognized in survivors particularly in cases without a clear diagnosis.