Fetal hydrocephaly: Diagnosis, prognosis and management

doi:10.1016/0301-5629(86)90062-1

Ultrasound in Medicine & Biology

Volume 12, Issue 12, December 1986, Pages 939-944

https://doi.org/10.1016/0301-5629(86)90062-1 Get rights and content

Abstract

Ventricle/hemisphere ( $V H$ ) ratio and head circumference (HC) measurements were obtained in 230 normal pregnancies between 16 and 28 weeks of gestation. The mean $V H$ ratio demonstrated a gradual decrease from 0.50 at 16 weeks to 0.26 at 26–28 weeks. HC showed a linear increase from 133 mm at 16 weeks to 268 mm at 28 weeks. In 9 other pregnancies, fetal hydrocephaly was established by routine ultrasound before 26 weeks of gestation. Whereas all $V H$ ratio values were situated above the upper normal limit, most of the corresponding HC values ( $69$ ) were within the normal range. Severe hydrocephaly ( $V H$ ratio > 3× upper confidence interval) was established in 7 out of 9 fetuses; associated intra or extra cranial structural anomalies were observed in 6 out of 9 fetuses. The implications of these findings for obstetric management of hydrocephaly are discussed.

References (17)

L.H. Nelson et al.
The wavering midline: a diagnostic sign of fetal hydrocephalus
Amer. J. Obstet. Gynecol.
(1984)
S. Campbell
Diagnosis of fetal abnormalities by ultrasound
S. Campbell
Fetal growth
S. Campbell et al.
The early diagnosis of fetal structural abnormalities
D.D. Cochrane et al.
Management of intrauterine hydrocephalus
J. Neurosurg.
(1982)
H. Denkhaus et al.
Ultrasonic measurement of the fetal ventricular system
Radiology
(1979)
R.L. Deter et al.
Fetal head and abdominal circumferences: II. A critical re-evaluation of the relationship to menstrual age
J. Clin. Ultrasound
(1982)
S.M. Donne
Fetal hydrocephalus

There are more references available in the full text version of this article.

Cited by (4)

Doppler colour flow mapping of fetal intracerebral arteries in the presence of central nervous system anomalies
1993, Ultrasound in Medicine and Biology
The adjunctive role of Doppler colour flow mapping in the evaluation of intracerebral morphology and arterial blood flow in the presence of normal and abnormal central nervous system morphology was determined. A total of 59 fetuses with suspected central nervous system pathology between 14 and 37 weeks of gestation was studied (median 31 weeks). One hundred and one fetuses with normal central nervous system anatomy between 14 and 37 weeks (median 19 weeks) served as controls. Visualisation of blood flow in one or more intracerebral arterial vessels was successful in more than 80% of normal fetuses. For the anterior, middle and posterior cerebral artery, the percentages were 63%, 89% and 45%, respectively, at 14–25 weeks and 74%, 100% and 55%, respectively, at 26–37 weeks of gestation. Intracerebral arterial flow identification was attempted in 52/59 (88%) affected fetuses. Identification of blood flow in one or more intracerebral arterial vessels was successful in $4052$ (77%) fetuses. End-diastolic flow velocities were present in at least one of the intracerebral arteries in $3940$ fetuses, absent in one case of hydrocephaly and raised in the presence of an intracerebral vascular tumour. Doppler colour flow mapping seems to provide only limited additional information on intracranial structural pathology.
The blood flow velocity waveform in the fetal internal carotid artery in the presence of hydrocephaly
1988, Early Human Development
The pulsatility index in the fetal internal carotid artery was studied in the presence of bilateral symmetrical hydrocephaly (n = 9) and unilateral hydrocephaly (n = 4). An elevated pulsatility index was demonstrated in five cases (38.5%) suggesting increased resistance to cerebral blood flow. In unilateral hydrocephaly a marked difference in pulsatility index was established between the normal and affected side. No relation could be established between the pulsatility index level and severity of ventriculomegaly or postnatal outcome. Both ventriculomegaly and increased intracranial pressure may play a role in the observed rise in pulsatility index.
The role of ultrasound in the early diagnosis of fetal structural defects following maternal anticonvulsant therapy
1988, Ultrasound in Medicine and Biology
A total of 162 pregnant subjects using anticonvulsant drugs were examined for fetal congenital defects over a period of five years. In 138 of these subjects, alpha-feto-protein (AFP) levels were determined in amniotic fluid at 16 weeks of gestation to rule out spina bifida. In all instances, a fetal anomaly scan was performed between 18 and 20 weeks of gestation. AFP levels were always within the normal range; neonatal examination revealed no spina bifida; however, in seven newborns, a single, or multiple structural defect was established. Apart from cases of severe hydrocephaly, hypospadia, and radius aplasia, the anomalies were too small to be detected by present-day ultrasound equipment. Couples should be informed of the limitations of ultrasound in the early detection of structural defects previously associated with the use of anticonvulsant drugs.
Isolated mild fetal ventriculomegaly
2004, Archives of Disease in Childhood: Fetal and Neonatal Edition

View full text

Original contributionFetal hydrocephaly: Diagnosis, prognosis and management

Abstract

Amer. J. Obstet. Gynecol.

Diagnosis of fetal abnormalities by ultrasound

Fetal growth

The early diagnosis of fetal structural abnormalities

Management of intrauterine hydrocephalus

J. Neurosurg.

Ultrasonic measurement of the fetal ventricular system

Radiology

Fetal head and abdominal circumferences: II. A critical re-evaluation of the relationship to menstrual age

J. Clin. Ultrasound

Fetal hydrocephalus

Original contribution
Fetal hydrocephaly: Diagnosis, prognosis and management